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Nebenwirkungen und Komplikationen der intravitrealen Triamcinolonacetonid-Therapie

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Zusammenfassung

Mit der Etablierung der intravitrealen Injektion von Triamcinolonacetonid (TA) in der klinischen Routine wird auch das Bewusstsein um mögliche Nebenwirkungen geschärft. Dabei wird die Diskussion durch die potenzielle Toxizität einzelner biounverträglicher Inhaltsstoffe beherrscht. Diese werden als wesentlicher pathogenetischer Faktor der sterilen Pseudoendophthalmitis angesehen, die jedoch durch die Aufreinigung kommerzieller Präparate weitgehend überwunden scheint. Auch sub- oder epiretinale Ablagerungen zeigen klinisch keinen Anhalt für eine retinale Toxizität.

Relevante Nebenwirkungen umfassen insbesondere das temporäre Kortikosteroidglaukom und die Progredienz einer vorbestehenden Katarakt. Als seltene, aber schwerwiegende Komplikation gilt die bakterielle Endophthalmitis, die im Zusammenhang mit dem angewandten Hygienestandard kritisch betrachtet werden muss. Sie kann durch die steroidinduzierte Immunsuppression klinisch maskiert sein. Als seltenere Komplikationen sind ein transienter Zentralarterienverschluss, konjunktivale Ulzerationen, eine Ablatio sowie möglicherweise die Reaktivierung einer Zytomegalievirusretinitis beschrieben.

Insgesamt sind die Komplikationen und Nebenwirkungen in ihrem Spektrum und den zugrunde liegenden Pathomechanismen zwar vielfältig, erscheinen in ihren Auswirkungen jedoch zumeist passager und gut beherrschbar.

Abstract

With the advent of intravitreal triamcinolone acetonid injections major focus was assigned to potential ocular side effects. The current discussion is dominated by the potential cytotoxicity of particular biologically incompatible components. Those are regarded as substantial pathogenetic factor of the sterile pseudoendophthalmitis that seems to be avoidable by meticulous purification of the commercially available preparations. Even sustained subretinal or epiretinal deposits disclosed no signs of retinal toxicity.

Major ocular side effects comprise temporary corticosteroid glaucoma and progressive cataract formation. Infectious endophthalmitis represents a rare but serious complication that might be set into critical context with hygienic surgical standards applied. Due to steroid-induced immune suppression clinical signs of inflammation might be masked and a proper diagnosis delayed. Other rare complications reported include a transient central retinal artery occlusion, conjunctival ulcerations, retinal detachment and potential reactivation of a cytomegalovirus retinitis.

In conclusion, ocular side effects and complications show a wide variety of clinical signs and underlying causal mechanisms. However, the consequences are mostly temporary and show a good response to therapeutic intervention.

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  1. Abteilung für Erkrankungen des vorderen und hinteren Augenabschnitts, Universitäts-Augenklinik, Tübingen

    G. B. Jaissle, P. Szurman & K. U. Bartz-Schmidt

  2. Abteilung für Erkrankungen des vorderen und hinteren Augenabschnitts, Universitäts-Augenklinik, Schleichstraße 12, 72076 , Tübingen

    G. B. Jaissle

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Jaissle, G.B., Szurman, P. & Bartz-Schmidt, K.U. Nebenwirkungen und Komplikationen der intravitrealen Triamcinolonacetonid-Therapie. Ophthalmologe 101, 121–128 (2004). https://doi.org/10.1007/s00347-003-0975-z

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