Wirkmechanismen, klinisches Profil und Stellenwert von Prostaglandin- und Prostamid-Analoga in der antiglaukomatösen Therapie

Zusammenfassung

Prostaglandin- und Prostamid-Analoga gehören zu einer neueren Gruppe von Substanzen, die in den 1990er-Jahren auf den Markt kamen. Sie haben die antiglaukomatöse Therapie durch ihre einfache Dosierung und ihren geringeren Nebenwirkungen revolutioniert. Heute sind Prostaglandin- und Prostamid-Analoga als First-Line-Therapie bei Patienten mit primären Offenwinkelglaukom und okulärer Hypertension zugelassen. Sie senken den intraokularen Druck primär über die Erhöhung des uveoskleralen Abflusses. Allerdings zeigen neuere Untersuchungen, dass sie auch einen Einfluss auf die trabekuläre Abflussfazilität haben und damit die konventionellen Abflusswege verbessern können. Prostaglandin- und Prostamid-Analoga zeichnen sich durch eine hohe Effizienz in der intraokularen Drucksenkung aus, die der von den anderen antiglaukomatösen Substanzgruppen überlegen ist. Sie scheinen insbesondere durch die primäre Abflussverbesserung eine gute Kontrolle von Druckfluktuationen über 24 Stunden zu haben. Des Weiteren haben sie geringere systemische Nebenwirkungen als β-Blocker. Ihr Einsatz ist allerdings mit höheren Kosten verbunden. Im Fall von unerwünschten Ereignissen gehen sie vor allem mit okulären Symptomen einher. Somit haben Prostaglandin- und Prostamid-Analoga aufgrund ihres guten klinischen Profils einen festen Stellenwert als primäre oder ergänzende Therapie in der Behandlung von Glaukomerkrankungen.

Abstract

Prostaglandin and prostamide analogues belong to a new substance group which came into the market in the 1990s. They have revolutionised antiglaucomatous therapy by their once-daily dosing regimen and fewer side effects. Today, prostaglandin and prostamide analogues are approved as first-line therapy for patients with primary open-angle glaucoma and ocular hypertension. They lower the intraocular pressure primarily by increasing the uveoscleral outflow. Recent investigations have shown that they also improve the trabecular outflow facility and thus the conventional outflow pathways. Prostaglandin and prostamide analogues are highly efficient in lowering the intraocular pressure, for which they are superior to other antiglaucomatous substance groups. In particular, they appear to have a good control of 24-hour intraocular pressure fluctuations by primarily improving the outflow pathways. Furthermore, they have less systemic side effects than β-blockers. However, their use is often associated with higher costs. In case of undesirable events, they mostly present with ocular symptoms. Based on their good clinical profile, prostaglandin and prostamide analogues play an important role in the primary and additive therapy for glaucoma.

Schlüsselwörter

Glaukom - intraokularer Druck - Prostaglandinanaloga

Key words

glaucoma - intraocular pressure - prostaglandin analogues

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