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Antiangiogene Therapie bei neovaskulärem Glaukom und nach Filterkissenchirurgie

Antiangiogenic treatment for neovascular glaucoma and after filtering surgery

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Zusammenfassung

Bevacizumab (Avastin®) wird derzeit als begleitendes Adjuvanz in der Behandlung der Rubeosis iridis und des Neovaskularisationsglaukoms diskutiert. Bei einer beginnenden Rubeosis scheint Bevacizumab präventiv zu wirken und verhindert die Progression der Erkrankung. Mit zunehmender Beteiligung des Kammerwinkels scheint die Einbindung von Bevacizumab in ein komplexeres, stadienabhängiges Therapieschema zur erfolgreichen intraokularen Druckkontrolle sinnvoll. Die Behandlung der ursächlichen Grunderkrankung, die zu der Rubeosis iridis geführt hat, ist in allen Stadien als Basisbehandlung indiziert. Ein weiteres mögliches Einsatzgebiet für Bevacizumab könnte in der postoperativen Angiogeneseinhibition während oder nach filtrierender Glaukomchirurgie bestehen. Mögliche Applikationsformen, die momentan Anwendung finden, sind die subkonjunktivale Gabe während eines filtrierenden Eingriffs, im Zuge eines postoperativen Needlings oder als intravitreale Gabe zeitgleich mit einer drucksenkenden Operation bei einem Neovaskularisationsglaukom. Der folgende Übersichtsartikel fasst bisherige Studienergebnisse über die Anwendung von Bevacizumab bei einer Rubeosis iridis, einem Neovaskularisationsglaukom und in der Filtrationschirurgie zusammen und gibt einen Ausblick auf mögliche zukünftige Therapieschemata.

Abstract

Bevacizumab is increasingly discussed as adjuvant treatment for rubeosis and for all stages of neovascular glaucoma. In incipient rubeosis bevacizumab has a preventive effect and arrests the progression of disease. In the case of increasing involvement of the anterior chamber angle, bevacizumab should be integrated into stage-adapted treatment to achieve successful control of intraocular pressure. The treatment of the causative ischemic stimulus is necessary in every stage of disease. One further indication for bevacizumab is the postoperative inhibition of angiogenesis after glaucoma surgery. Possible routes of administration are subconjunctival application during trabeculectomy, postoperative needling, or intravitreal injection during a filtrating operation. This review summarizes results of current studies about bevacizumab for rubeosis, neovascular glaucoma, or filtrating surgery and adds future perspectives for possible therapeutic schemes.

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  1. Eye Hospital, University Clinic of Schleswig-Holstein, University of Lübeck, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    J. Lüke, M. Lüke & S. Grisanti

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  1. J. Lüke
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Lüke, J., Lüke, M. & Grisanti, S. Antiangiogene Therapie bei neovaskulärem Glaukom und nach Filterkissenchirurgie. Ophthalmologe 106, 407–412 (2009). https://doi.org/10.1007/s00347-009-1940-2

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  • DOI: https://doi.org/10.1007/s00347-009-1940-2

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