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Immunmodulation bei perforierender Keratoplastik

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Zusammenfassung

Die immunprivilegierte Sonderrolle der Hornhaut begünstigt das Transplantatüberleben nach Keratoplastik. Dennoch sind präventive Maßnahmen zur Verhinderung immunmediierter Transplantatabstoßung unentbehrlich. Während bis vor wenigen Jahren dafür nur Kortikosteroide eingesetzt wurden, steht heute eine Vielzahl von Substanzen zu Verfügung, die mit unterschiedlicher Spezifität eingreifen und sich auch bezüglich des Nebenwirkungsprofils deutlich unterscheiden. Das Spektrum reicht von proliferationshemmenden Substanzen (Azathioprin, Methotrexat) über Calcineurinantagonisten mit Wirkung auf T-Lymphozyten (Cyclosporin A, FK506) bis zu Substanzen mit hoher Spezifität (monoklonale Antikörper) gegen Subpopulationen von T-Lymphozyten, Adhäsionsmoleküle oder andere Immunmoleküle. Aufgrund des breiten Potenzials an Nebenwirkungen bei einer nichtvitalen Indikation und des oft auch ungewohnten Umgangs mit diesen Wirkstoffen werden diese Substanzen bei der perforierenden Keratoplastik durch den Ophthalmologen nur zögernd genutzt. Die Wirkungsweise, Ergebnisse und Risiken dieser Pharmaka sollen daher dargestellt werden. Dies umfasst keine vollständige Übersicht der verfügbaren Substanzen, sondern soll die klinisch gebräuchlichsten Wirkstoffe für die Anwendung bei perforierender Keratoplastik charakterisieren. Ferner soll auf neue, interessante Entwicklungen hingewiesen werden, die sich mit dem Ziel der Toleranzinduktion nach Keratoplastik auseinander setzen.

Abstract

The immune privileged nature of the cornea contributes to the favourable outcome in corneal grafts. However, preventive measures are necessary to reduce allograft rejection particular in “high-risk” cases. Although corticosteroids are still a major component of our immunopharmacological armentarium, they might be supplemented by other more specific immunomodulating agents. The spectrum includes agents such as azathioprin, methotrexate or more specific calcineurin inhibitors affecting T-cells (cyclosporin A, FK506) and highly selective monoclonal antibodies directed against T-cell subpopulations and other targets. In order to better evaluate the risks and benefit of these agents, the properties of established and forthcoming agents are presented. In addition, this review attempts to address some new concepts of tolerance induction following penetrating keratoplasty.

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  1. Augenklinik, Charité, Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin

    U. Pleyer

  2. Augenklinik, Charité, Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 , Berlin

    U. Pleyer

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Pleyer, U. Immunmodulation bei perforierender Keratoplastik. Ophthalmologe 100, 1036–1044 (2003). https://doi.org/10.1007/s00347-003-0954-4

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