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Pathogenetische Konzepte zur Pigmentepithelabhebung bei exsudativer AMD

Pathogenetic concepts for pigment epithelial detachment in exudative AMD

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Zusammenfassung

Die Abhebung des retinalen Pigmentepithels (PED) als eine spezifische Manifestation bei der exsudativen altersabhängigen Makuladegeneration (AMD) kann zu einer erheblichen Minderung des zentralen Sehvermögens führen. Für eine erfolgreiche therapeutische Intervention ist das Verständnis der Faktoren, die für die Entstehung der PED wichtig sind, notwendig. Zentrale pathogenetische Ideen dazu liefert die Theorie der Abnahme der hydraulischen Konduktivität der Bruch-Membran. Diese wird multifaktoriell durch eine zunehmende Lipideinlagerung, eine verstärkte Kollagenvernetzung und eine Änderung in der Zusammensetzung von gewebsauflösenden Enzymen und deren Inhibitoren hervorgerufen. Die Assoziation von Gefäßneubildungen und einer unveränderten RPE-Pumpaktivität kann auf dieser Grundlage zum klinischen Bild der serösen PED im Rahmen der exsudativen AMD führen.

Abstract

Retinal pigment epithelial detachment (PED) as a specific manifestation in exudative age-related macular degeneration (AMD) may lead to a substantial decrease of central vision. An understanding of important events during the development of PED is necessary for a successful therapeutic intervention. At present the leading pathogenetic theory is that of reduced hydraulic conductivity of Bruch’s membrane. The mechanisms underlying this process are caused by increased deposition of lipids, enhanced collagen cross-linking and alteration in the ratio of tissue-dissolving enzymes and their inhibitors. The association of newly formed vessels and an unaltered RPE pump activity can lead to the clinical picture of serous PED during exudative AMD.

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    S. Wasmuth

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Wasmuth, S. Pathogenetische Konzepte zur Pigmentepithelabhebung bei exsudativer AMD. Ophthalmologe 107, 1109–1114 (2010). https://doi.org/10.1007/s00347-010-2142-7

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