Rückgang von Makulaödemen unter Ranibizumab-Therapie des Partnerauges – Kollateraleffekte oder natürlicher Verlauf?

Zusammenfassung

Hintergrund: Unter Ranibizumab-Therapie ist gelegentlich eine Abnahme der Netzhautdicke am unbehandelten Partnerauge zu beobachten. Hierbei könnte es sich um Schwankungen im Rahmen des natürlichen Verlaufs handeln. Denkbar wäre jedoch auch ein Zusammenhang mit den intravitrealen Injektionen des behandelten Auges vermittels einer, wenngleich geringfügigen, systemischen Resorption. Patienten: Beschreibung von 40 Patienten mit exsudativer altersabhängiger Makuladegeneration (AMD) oder diabetischem Makulaödem (DMÖ), bei denen unter Ranibizumab ein Rückgang der Netzhautdicke am Partnerauge beobachtet wurde (Beobachtungsgruppe). Vergleich mit einer ebenso großen Kontrollgruppe von AMD- und Diabetespatienten unter Ranibizumab mit einem am Partnerauge bestehenden Makulaödem, das im Verlauf persistierte oder zunahm. Ergebnisse: In der Beobachtungsgruppe hatten 58 % der Patienten ein DMÖ und 42 % der Patienten eine AMD; in der Kontrollgruppe hatten 25 % der Patienten ein DMÖ und 75 % der Patienten eine AMD (p = 0,003). Die Netzhautdicke vor Injektion betrug in der Beobachtungsgruppe 519 ± 126 µm und in der Kontrollgruppe 432 ± 87 µm (p = 0,003). Die Netzhautdicke am Partnerauge zu diesem Zeitpunkt betrug in der Beobachtungsgruppe 511 ± 162 µm und in der Kontrollgruppe 436 ± 149 µm (p = 0,036). Die Reduktion der Netzhautdicke am injizierten Auge betrug in der Beobachtungsgruppe 214 ± 144 µm und in der Kontrollgruppe 150 ± 89 µm (p = 0,06). Schlussfolgerung: In der Gruppe von Patienten, bei denen unter Ranibizumab eine Reduktion der Netzhautdicke des unbehandelten Partnerauges zu beobachten war, befanden sich mehr Patienten mit einem behandlungsbedürftigen diabetischen Makulaödem als in einer vergleichbaren Kontrollgruppe. Die Patienten wiesen sowohl am Injektions- als auch am Partnerauge eine größere Netzhautdicke vor Injektion auf als diejenigen der Kontrollgruppe. Eine Aussage zu einer möglichen Kausalität wäre nur über eine prospektive Studie möglich.

Abstract

Background: During unilateral treatment with ranibizumab, a reduction in the retinal thickness in the non-treated eye is occasionally observed. This may be due to the natural progression of the condition. It could also be the consequence of systemic absorption of intravitreal injections, leading to effects in the contralateral eye. Patients: We describe 40 patients with either exsudative age-related macular degeneration (AMD) or diabetic macular oedema (DME). During treatment with ranibizumab, a reduction in retinal thickness in the contralateral eye was observed in this group (observation group). Another 40 AMD or diabetes patients under treatment with ranibizumab were selected as control group. These patients showed retinal swelling in the contralateral eye, which remained stable or increased. Results: In the observation group, 58 % of the patients had a DME and 42 % had an AMD; in the control group, 25 % of the patients had a DME and 75 % of the patients had an AMD (p = 0.003). Retinal thickness before injection was 519 ± 126 µm in the observation group and 432 ± 87 µm in the control group (p = 0.003). Retinal thickness in the contralateral eye was then 511 ± 162 µm in the observation group and 436 ± 149 µm in the control group (p = 0.036). The reduction in retinal thickness in the injected eye was 214 ± 144 µm in the observation group and 150 ± 89 µm in the control group (p = 0.06). Conclusion: In the group of patients that showed reduction in retinal thickness under ranibizumab in the contralateral eye, there were more diabetes patients than in the comparable control group. Even before injection, these patients showed higher retinal thickness in both eyes than did those in the control group. Further prospective studies would be required to confirm a possible causal connection between ranibizumab injection and reduction in DME in the contralateral eye.

Schlüsselwörter

Retina - Ranibizumab - intravitreale Injektionen

Key words

retina - ranibizumab - intravitreal injections

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