Skip to main content
SpringerLink
Log in

Diabetische Makulopathie

Diagnose und Behandlung

Diabetic maculopathy

Diagnosis and treatment

  • CME Weiterbildung · Zertifizierte Fortbildung
  • Published:
Der Ophthalmologe Aims and scope Submit manuscript

Zusammenfassung

Trotz medikamentöser Fortschritte und teurer Präventionsprogramme steigt die Prävalenz der diabetischen Retinopathie, einer der häufigsten Erblindungsursachen in Deutschland, aufgrund des demografischen Wandels weiter an. Nach wissenschaftlichem Stand ist die „focal/grid“-Laserkoagulation, in Kombination mit der intravitrealen operativen Medikamentenapplikation (IVOM) von VEGF-Inhibitoren (VEGF: „vascular endothelial growth factor“), zurzeit die wirksamste Therapie des klinisch signifikanten Makulaödems mit Foveabeteiligung. Vitreomakuläre Interface-Anomalien erfordern den Einsatz der modernen Netzhautchirurgie. Für die ischämische Makulopathie gibt es keine effektive Behandlung. Die zeitgemäße Einstellung des Blutzuckerspiegels und die optimale Kontrolle relevanter Risikofaktoren haben in der interdisziplinären Abstimmung einen festen Stellenwert. Innovative Entwicklungen in der pharmakologischen Therapie eröffnen eine optimistische Perspektive auf mögliche Funktionsverbesserungen, die die Lebensqualität der Diabetespatienten steigern werden.

Abstract

Due to demographic change the incidence of diabetic retinopathy has risen in spite of new facilities and prevention campaigns and is still one of the leading causes of blindness in Germany. The combination of focal/grid laser photocoagulation and an intravitreal anti-VEGF (vascular endothelial growth factor) regimen is the first line approach for clinically significant macular edema with foveal involvement and is evidence-based. Vitreomacular interface abnormalities can be effectively treated by modern vitreomacular surgery. Unfortunately, no proven treatment modality can be provided for ischemic maculopathy. The management of systemic risks factors, such as hyperglycemia and arterial hypertension, remains a task of great importance despite all modifications and increase of knowledge during recent years. Innovative developments in the field of intravitreal pharmacotherapy have opened up new vistas. There are good prospects that modern ophthalmology will not be limited to preserving visual function but to allow improvements and consequently enhance health-related quality of life for diabetic patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7

Literatur

  1. Aiello LP, Avery RL, Arrigg PG et al (1994) Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med 331:1480–1487

    Article  CAS  PubMed  Google Scholar 

  2. Bhavsar AR, Ip MS, Glassman AR, DRCRnet and the SCORE Study Groups (2007) The risk of endophthalmitis following intravitreal triamcinolone acetonide injection in the DRCRnet and SCORE clinical trials. Am J Ophthalmol 144:454–456

    Article  CAS  PubMed  Google Scholar 

  3. Biester S, Ziemssen F, Ulrich Bartz-Schmidt K, Gelisken F (2009) Is intravitreal bevacizumab treatment effective in diffuse diabetic macular edema? Graefes Arch Clin Exp Ophthalmol 247:1575–1577

    Article  PubMed  Google Scholar 

  4. Bolz M, Schmidt-Erfurth U, Deak G et al (2009) Optical coherence tomographic hyperreflective foci: a morphologic sign of lipid extravasation in diabetic macular edema. Ophthalmology 116:914–920

    Article  PubMed  Google Scholar 

  5. Bresnick HB (1983) Diabetic maculopathy. A critical review highlighting diffuse macular edema. Ophthalmology 90:1301–1317

    CAS  PubMed  Google Scholar 

  6. Browning DJ, Glassman AR, Aiello LP et al (2008) Optical coherence tomography measurements and analysis methods in optical coherence tomography studies of diabetic macular edema. Ophthalmology 115:1366–1371

    Article  PubMed  Google Scholar 

  7. Brucker AJ, Qin H, Antoszyk AN et al (2009) Observational study of the development of diabetic macular edema following panretinal (scatter) photocoagulation given in 1 or 4 sittings. Arch Ophthalmol 127:132–140

    Article  PubMed  Google Scholar 

  8. Chung EJ, Roh MI, Kwon OW, Koh HJ (2008) Effects of macular ischemia on the outcome of intravitreal bevacizumab therapy for diabetic macular edema. Retina 28:957–963

    Article  PubMed  Google Scholar 

  9. Cunningham ET Jr, Adamis AP, Altaweel M et al (2005) A phase II randomized double-masked trial of pegaptanib, an antivascular endothelial growth factor aptamer, for diabetic macular edema. Ophthalmology 112:1747–1757

    Article  PubMed  Google Scholar 

  10. Diabetic Retinopathy Clinical Research Network (2008) A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema. Ophthalmology 115:1447–1449

    Article  Google Scholar 

  11. Diabetic Retinopathy Clinical Research Network (2010) Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology 117(6):1064–1077, DOI 10.1016/j.ophtha.2010.02.031

    Article  Google Scholar 

  12. Early Treatment Diabetic Retinopathy Study Research Group (1985) Photocoagulation for diabetic macular edema. Report number 1. Arch Ophthalmol 103:1796–1806

    Google Scholar 

  13. Ejaz S (2008) Importance of pericytes and mechanisms of pericyte loss during diabetes retinopathy. Diabetes Obes Metab 10:53–63

    CAS  PubMed  Google Scholar 

  14. Engelmann K, on behalf of the RESOLVE study group (2009) Safety and efficacy of ranibizumab treatment in patients with diabetic macular oedema: 12-months results of the RESOLVE study. Diabetologia [Suppl 1] 52:S31

  15. Forooghian F, Stetson PF, Meyer SA et al (2010) Relationship between photoreceptor outer segment length and visual acuity in diabetic macular edema. Retina 30:63–70

    Article  PubMed  Google Scholar 

  16. Funatsu H, Noma H, Mimura T et al (2009) Association of vitreous inflammatory factors with diabetic macular edema. Ophthalmology 116:73–79

    Article  PubMed  Google Scholar 

  17. Hammes HP, Bertram B, Bornfeld N et al (2004) Diagnostik, Therapie und Verlaufskontrolle der diabetischen Retinopathie und Makulopathie. In: Scherbaum WA, Kiess W (Hrsg) Evidenzbasierte Leitlinien der DDG, aktualisierte Version. Deutsche Diabetes-Gesellschaft, Bochum, www.deutsche-diabetes-gesellschaft.de

  18. Hanefeld M, Schönauer M, Forst T (2010) Blutzucker-Senkung und kardiovaskulärer Vorteil: Was wissen wir heute? Dtsch Med Wochenschr 135:301–307

    Article  CAS  PubMed  Google Scholar 

  19. Hartnett EM, Tinkham N, Paynter L et al (2009) Aqueous vascular endothelial growth factor as a predictor of macular thickening following cataract surgery in patients with diabetes mellitus. Am J Ophthalmol 148:895–901

    Article  CAS  PubMed  Google Scholar 

  20. Helbig H, Kellner U, Bornfeld N, Foerster MH (1997) Long-term vision follow-up after vitrectomy in diabetic retinopathy. Ophthalmologe 94:268–272

    Article  CAS  PubMed  Google Scholar 

  21. Hörle S, Grüner F, Kroll P (2002) Epidemiologie diabetischer Erblindungen – eine Übersicht. Klin Monatsbl Augenheilk 219:777–784

    Article  Google Scholar 

  22. Kaji Y, Usui T, Ishida S et al (2007) Inhibition of diabetic leucostasis and blood-retinal barrier breakdown with a soluble form of a receptor for advanced glycation end products. Invest Ophthalmol Vis Sci 48:858–865

    Article  PubMed  Google Scholar 

  23. Kim BY, Smith SD, Kaiser PK (2006) Optical coherence tomographic patterns of diabetic macular edema. Am J Ophthalmol 142:405–412

    Article  PubMed  Google Scholar 

  24. Klein R, Klein BE, Moss SE et al (1984) The Wisconsin epidemiologic study of diabetic retinopathy. IV. Diabetic macula edema. Ophthalmology 91:1464–1474

    CAS  PubMed  Google Scholar 

  25. Krumpazky HG, Lüdtke R, Mickler A et al (1999) Blindness incidence in Germany. Ophthalmologica 213:176–182

    Article  Google Scholar 

  26. Kumagai K, Furukawa M, Ogino N (2009) Long-term follow-up of vitrectomy for diffuse nontractional diabetic macular edema. Retina 29:464–472

    Article  PubMed  Google Scholar 

  27. Lee CM, Olk RJ (1983) Modified grid laser photocoagulation for diffuse diabetic macular edema: long term results. Ophthalmology 90:1301–1317

    Google Scholar 

  28. Massin P, Duguid G, Erginay A et al (2003) Optical coherence tomography for evaluating diabetic macular edema before and after vitrectomy. Am J Ophthalmol 135:169–177

    Article  PubMed  Google Scholar 

  29. Matsuoka M, Ogata N, Minamino K, Matsumura M (2007) Leukostasis and pigment epithelium-derived factor in rat models of diabetic retinopathy. Mol Vis 13:1058–1065

    CAS  PubMed  Google Scholar 

  30. Nguyen QD, Shah SM, Heier JS et al (2009) Primary end point (six months) results of the ranibizumab for edema of the macula in diabetes (READ-2) study. Ophthalmology 116:2175–2181

    Article  PubMed  Google Scholar 

  31. Nicholson BP, Schachat AP (2010) A review of clinical trials of anti-VEGF agents for diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 248(7):915–930

    Article  CAS  PubMed  Google Scholar 

  32. Parravano M, Menchini F, Virgili G (2009) Antiangiogenic therapy with anti-vascular endothelial growth factor modalities for diabetic macular oedema. Cochrane Database Syst Rev 7:CD007419

    Google Scholar 

  33. Poulaki V, Qin W, Joussen AM et al (2002) Acute intensive insulin therapy exacerbates diabetic blood-retinal barrier breakdown via hypoxic-inducable factor 1-alpha and VEGF. J Clin Invest 109:805–815

    CAS  PubMed  Google Scholar 

  34. Schernthaner G (2010) Diabetes and cardiovascular disease: is intensive glucose control beneficial or deadly? Lessons from ACCORD, ADVANCE, VADT, UKPDS, PROactive and NICE-SUGAR. Wien Med Wochenschr 160:8–19

    Article  PubMed  Google Scholar 

  35. Shah AS, Chen SH (2010) Cataract surgery and diabetes. Curr Opin Ophthalmol 21:4–9

    Article  PubMed  Google Scholar 

  36. Shweiki D, Neeman M, Itin A, Keshet E (1995) Induction of vascular endothelial growth factor expression by hypoxia and by glucose deficiency in multicell spheroids: implications for tumor angiogenesis. Proc Natl Acad Sci USA 92:768–772

    Article  CAS  PubMed  Google Scholar 

  37. Szaflik JP, Wysocki T, Kowalski M et al (2008) An association between vascular endothelial growth factor gene promoter polymorphisms and diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 246:39–43

    Article  CAS  PubMed  Google Scholar 

  38. Takamura Y, Kubo E, Akagi Y (2009) Analysis of the effect of intravitreal bevacizumab injection on diabetic macular edema after cataract surgery. Ophthalmology 116:1151–1157

    Article  PubMed  Google Scholar 

  39. Trautner C, Haastert B, Richter B et al (2003) Incidence of blindness in Southern Germany due to glaucoma and degenerative conditions. Invest Ophthalmol Vis Sci 44:1031–1034

    Article  PubMed  Google Scholar 

  40. Wang Y, Ng MC, Lee SC et al (2004) Epidemiology of diabetic retinopathy and macular oedema: a systematic review. Eye 18:963–983

    Article  Google Scholar 

  41. Yokoi M, Yamigishi S, Takeuchi M et al (2007) Positive correlation between vitreous levels of advanced glycation end products and vascular endothelial growth factor in patients with diabetic retinopathy sufficiently treated with photocoagulation. Br J Ophthalmol 91:397–398

    Article  PubMed  Google Scholar 

  42. Ziemssen F (2008) Therapie der diabetischen Retinopathie. In: Bartz-Schmidt KU (Hrsg) Intravitreale Pharmakotherapie. Schattauer, Stuttgart

  43. Ziemssen F, Bartz-Schmidt KU, Grisanti (2006) (Side) effects of VEGF inhibition. Ophthalmologe 103:484–492

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Die Autoren weisen darauf hin, dass folgende Beziehungen zu Herstellern von Anti-VEGF-Präparaten bestehen: F. Gelisken (Novartis, K), F. Ziemssen (Novartis: K; OSI Eyetech, F). Trotz eines potenziellen Interessenkonflikts bemüht sich der Beitrag um eine unabhängige und neutrale Bewertung.

F Studienunterstützung und andere Drittmittel

K Kostenerstattung, Honorar, Einladung zu Vorträgen

Author information

Authors and Affiliations

  1. Abteilung für Augenheilkunde, Eberhard-Karl-Universität Tübingen, Schleichstraße 12, 72076, Tübingen, Deutschland

    F. Gelisken & F. Ziemssen

Authors
  1. F. Gelisken
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Ziemssen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Gelisken.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gelisken, F., Ziemssen, F. Diabetische Makulopathie. Ophthalmologe 107, 773–788 (2010). https://doi.org/10.1007/s00347-010-2202-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00347-010-2202-z

Schlüsselwörter

Keywords

Search

Navigation