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Arthritis und Rheuma 2019; 39(06): 409-413
DOI: 10.1055/a-0992-3080
Kinderrheumatologie | Übersichtsartikel
© Georg Thieme Verlag KG Stuttgart · New York

Therapie der kindlichen Uveitis intermedia und posterior mit intravitrealen Steroiden

Intravitreal steroids for the treatment of paediatric intermediate or posterior uveitis
Sibylle Winterhalter
1   Universitäts Augenklinik, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
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Publikationsverlauf

Publikationsdatum:
18. Dezember 2019 (online)

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ZUSAMMENFASSUNG

Die Uveitis im Kindesalter weist ein hohes Erblindungsrisiko auf. Bei einer nicht infektiösen Uveitis intermedia und posterior sind lokal applizierte Steroid-Augentropfen nicht ausreichend wirksam, sodass bei Visusverschlechterung und Komplikationen eine systemische Therapie erfolgen muss. Diese entspricht im Wesentlichen dem Therapiealgorithmus der JIA-Assoziierten Uveitis anterior wie in der S2k-Leitlinie 045–012 zur Diagnostik und antientzündlichen Therapie der Uveitis bei juveniler idiopathischer Arthritis mit Stand 01/2018 beschrieben. Bei pädiatrischen Patienten jedoch, die nur an einem Auge ohne Systemerkrankung leiden, wäre eine intravitreale Therapie wünschenswert, um Nebenwirkungen einer systemischen Therapie zu vermeiden. Intravitreal verabreichte Steroide weisen zwar eine sehr gute Wirksamkeit auf. Leider besteht jedoch das Risiko für ein Steroid-induziertes Glaukom sowie eine Steroid-induzierte Katarakt, sodass intravitreal verabreichte Steroide laut S2k-Leitlinie nur als Rescue-Therapie genutzt werden sollten.

ABSTRACT

Uveitis in childhood carries a high risk for vision-threatening complications. In non infectious intermediate and posterior uveitis topical steroids are usually not effective enough and systemic treatment may be necessary in cases of visual deterioration and complications. In these cases systemic therapy follows the therapy algorithm of the S2k-guidelines 045–012 for the diagnosis and anti inflammatory therapy of uveitis in juvenile idiopathic arthritis 01/2018. In paediatric patients with only one eye involvement without systemic disease, an intravitreal therapy would be preferable to avoid systemic side effects. An intravitreal steroid application is highly effective, but carries a risk for steroid induced glaucoma and steroid induced cataract. Therefore the S2k-guidelines only recommend intravitreal steroid application as a rescue therapy.

Schlüsselwörter

Uveitis intermedia - Uveitis posterior - intravitreale Steroide - Dexamethasonimplantate

Keywords

Intermediate uveitis - posterior uveitis - intravitreal steroids - dexamethasone implants
 

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