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Pharmakologische Ansätze zur Behandlung der proliferativen Vitreoretinopathie

Pharmacological approach to treatment of proliferative vitreoretinopathy

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Zusammenfassung

Die proliferative Vitreoretinopathie (PVR) ist die wichtigste Komplikation der Netzhautablösung und die Hauptursache für ein Therapieversagen in der vitreoretinalen Chirurgie. Im Rahmen der PVR kommt es zur Neuentstehung fibrozellulärer Membranen, deren Kontraktion zur traktiven Netzhautablösung führen kann. Epithelial mesenchymale Transformation, Adhäsion, Migration und Proliferation von durch die Verletzung der Netzhaut freigesetzten retinalen Pigmentepithelzellen, Gliazellen, Hyalozyten und Immunzellen im Zusammenspiel mit der Freisetzung von Wachstumsfaktoren gelten als initiale Schritte in der Pathogenese der PVR. Eine pharmakologische Beeinflussung dieser frühen zellvermittelten Prozesse ist ein interessanter Ansatz, um die Ergebnisse in der chirurgischen Therapie von Netzhautablösungen in Zukunft zu verbessern oder etwa die Ausbildung einer PVR zu verhindern. In den wenigen vorhandenen klinischen Studien überzeugte keine der bisher getesteten Substanzen durch eine eindeutige Wirksamkeit, sodass sich bislang keine adjuvante pharmakologische Therapie in der klinischen Routine etablieren konnte. Ein zunehmendes Verständnis der zugrunde liegenden Pathogenese der PVR führte in den vergangenen Jahren jedoch zur Entdeckung vieler interessanter experimenteller therapeutischer Ansätze, die einen ersten Grundstein zur Entwicklung einer medikamentösen Therapie der PVR darstellen könnten. Der folgende Beitrag gibt einen Überblick über bisherige klinische Studien zur Testung medikamentöser Therapieansätze und widmet sich insbesondere vielversprechenden experimentellen Ideen.

Abstract

Proliferative vitreoretinopathy (PVR) is the major cause of persistent loss of vision after retinal detachment surgery and is characterized by the formation of scar-like fibrocellular membranes on the neuroretina giving rise to tractional retinal (re-)detachment. Epithelial-mesenchymal transition, adhesion, migration and proliferation of retinal pigment epithelial (RPE) cells disseminated from the normal site at Bruch’s membrane in concert with an activation of glial cells, hyalocytes and immune cells are key cellular events in the onset of the disease. The interplay between the cellular events and various growth factors, cytokines and matrix proteins thereby drives the undesirable formation of PVR membranes. Blocking these pathological events would greatly enhance the overall prognosis of surgical treatment. Clinical trials assessing the efficacy of antiproliferative and anti-inflammatory substances have yielded mixed results. Thus no safe or sufficiently effective pharmacological agent has so far been established in the clinical routine. Recent advances in the fundamental understanding of the pathogenesis of PVR aided in the identification of several new therapeutic targets to block the cellular events intrinsic to the disease. This article gives an overview of the results for adjunct therapies already tested in clinical studies and highlights experimental concepts for novel treatment strategies.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C.S. Priglinger und S. Priglinger geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Augenklinik, AKH Linz, Linz, Deutschland

    C.S. Priglinger FEBO & S. Priglinger

  2. Augenklinik, Ludwig-Maximilans-Universität, Mathildenstr. 8, 80336, München, Deutschland

    C.S. Priglinger FEBO

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  2. S. Priglinger
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Correspondence to C.S. Priglinger FEBO.

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Priglinger, C., Priglinger, S. Pharmakologische Ansätze zur Behandlung der proliferativen Vitreoretinopathie. Ophthalmologe 110, 948–959 (2013). https://doi.org/10.1007/s00347-013-2832-z

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