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Früher antiexsudativer Effekt – OCT-Monitoring nach intravitrealer Bevacizumab-Applikation

Early antiexudative response – OCT monitoring after intravitreal bevacizumab injection

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Zusammenfassung

In der Induktion einer gesteigerten Gefäßpermeabilität ist VEGF 50.000-mal potenter als Histamin. In isolierten Gefäßen wird bereits in den ersten Minuten eine deutliche Erhöhung der hydraulischen Leitfähigkeit und des Diffusionskoeffizienten beobachtet. Es folgt eine anhaltende Phase, in der die Barrierefunktion der Gefäßwand selektiv aufgehoben ist. Die spezifische Inhibition des angiogenen, vasoaktiven und permeabilitätsfördernden Proteins VEGF ist mit neuen Wirkstoffen möglich geworden, von denen Bevacizumab als erstes für den klinischen („off label“) Einsatz frei verfügbar ist. Ödeme der Netzhaut entstehen nach Austritt von Wasser und niedermolekularen Stoffen in das Interstitium und stellen für unterschiedliche okuläre Pathologien eine wesentliche prognostische Determinate der Funktion dar. Die ersten Erfahrungen mit der antihyperpermeablen Wirkung von Bevacizumab deuten auf eine frühzeitige und potente Abdichtung pathologischer Leckage hin. Zukünftige Untersuchungen müssen allerdings erst noch zeigen, für welche Erkrankungen überhaupt ein dauerhafter Nutzen erreicht werden kann.

Abstract

VEGF is more potent than histamine by a factor of 50,000 for inducing increased vessel permeability. Already in the first few minutes, hydraulic conductivity and diffusive permeability are significantly increased, followed by a longer-lasting, marked leakage over 20 h. Specific inhibition of the angiogenic, vasoactive, and permeability-inducing protein VEGF is now possible by new drugs, one of which is the first available (off-label) treatment in Germany for routine clinical use (Avastin). Retinal edema is composed of increased outflow of water and low molecular substances in the interstitial environment and is an important determinate of functional development in different ocular diseases. First experiences with the anti-hyperpermeability effect show early response and high potential in pathologic leakage. Future examinations have to assess when a permanent benefit can be achieved in respect to the other antiproliferative capabilities of the drug.

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Danksagung

Wir danken allen fleißigen Mitarbeitern, insbesondere Dr. Sabine Biester, Dr. Martin Leitritz und Dr. Efdal Yörük für die Hilfe bei der Befunderhebung.

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Authors and Affiliations

  1. Universitätsaugenklinik Tübingen, Schleichstraße12, 72076 , Tübingen

    M. Völcker, S. Peters, W. Inhoffen &  F. Ziemssen

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  1. M. Völcker
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  2. S. Peters
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  3. W. Inhoffen
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  4. F. Ziemssen
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Correspondence to F. Ziemssen.

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Völcker, M., Peters, S., Inhoffen, W. et al. Früher antiexsudativer Effekt – OCT-Monitoring nach intravitrealer Bevacizumab-Applikation. Ophthalmologe 103, 476–483 (2006). https://doi.org/10.1007/s00347-006-1356-1

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