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Pathogenese der Frühgeborenenretinopathie

Pathogenesis of retinopathy of prematurity

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Zusammenfassung

Die Frühgeborenenretinopathie („retinopathy of prematurity“, ROP) stellt ein komplexes Krankheitsbild dar, dessen multifaktorielle Pathogenese trotz wichtiger Forschungsfortschritte bisher nur unvollständig verstanden ist. Wichtige pathogenetische Faktoren sind einerseits das Gestationsalter bei Geburt sowie das Geburtsgewicht, andererseits postnatale Faktoren wie Sauerstoffexposition, Gewichtszunahme und Expression angiogener Wachstumsfaktoren. Einige dieser wesentlichen Aspekte der ROP-Pathogenese sollen im vorliegenden Beitrag diskutiert und in den klinischen Kontext gestellt werden. Insbesondere der Einzug der Anti-VEGF-Therapie als Behandlungsoption für die ROP lässt es sinnvoll erscheinen, die Rolle von VEGF in der Pathogenese der ROP zu beleuchten. Darüber hinaus werden weitere Faktoren diskutiert, die teilweise der erhöhten VEGF-Expression pathomechanistisch vorgeschaltet sind und daher mögliche protektive Behandlungsansätze darstellen. Zu diesen gehört vor allem der systemische Wachstumsfaktor IGF-1. Schließlich werden Faktoren wie die postnatale Gewichtszunahme diskutiert, die sich in Studien als Screeningparameter bewährt haben und früh prognostische Aussagen über die zu erwartende Schwere der ROP erlauben.

Abstract

Retinopathy of prematurity (ROP) is a complex disease with a multifactorial pathogenetic cascade that is still only partially understood. Important pathogenetic factors are gestational age at birth and birth weight. Potent postnatal factors are exposure to supplemental oxygen, slow weight gain and expression of angiogenic growth factors. Some of these crucial aspects of ROP pathogenesis will be discussed in this article and put into clinical context. With the introduction of intravitreal anti-VEGF (vascular endothelial growth factor) treatment into ROP therapy, the pathomechanistic role of VEGF in ROP deserves a special focus. Apart from VEGF, other factors will be discussed that may precede VEGF upregulation and thus may represent targets for an earlier and potentially protective intervention. Among these insulin-like growth factor 1 (IGF-1) appears to be most prominent. Finally, factors such as postnatal weight gain will be discussed in light of their potential role as screening parameters and their ability to predict ROP severity.

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: Stahl: Beratertätigkeit für Novartis, Forschungsförderung: Novartis. Lagreze: Beratertätigkeit für Merz, Allergan. Agostini: Beratertätigkeit für Genentech, Novartis, Bayer Healthcare, Forschungsförderung: Novartis.

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  1. Universitäts-Augenklinik Freiburg, Kilianstr. 5, 79106, Freiburg, Deutschland

    A. Stahl, W.A. Lagrèze & H.T. Agostini

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  1. A. Stahl
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  2. W.A. Lagrèze
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  3. H.T. Agostini
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Correspondence to A. Stahl.

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Stahl, A., Lagrèze, W. & Agostini, H. Pathogenese der Frühgeborenenretinopathie. Ophthalmologe 109, 1174–1181 (2012). https://doi.org/10.1007/s00347-012-2616-x

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