Die Intraokularlinse als Arzneimittelträger: Stand der Forschung und Ausblick

Zusammenfassung

Die Intraokularlinse (IOL) als Medikamententräger stellt ein therapeutisches Konzept mit großem Entwicklungspotenzial dar. Häufige Folgen der Kataraktchirurgie, wie der Nachstar oder schwerwiegende Komplikationen wie ein starker intraokularer Reizzustand oder die Endophthalmitis, könnten durch die Implantation einer pharmakologisch modifizierten Kunstlinse im Idealfall mitbehandelt bzw. in ihrer Ausprägung geschwächt werden, ohne weitere therapeutische Maßnahmen einzuleiten. Eine pharmakologische IOL-Modifikation kann an der Oberfläche erfolgen („IOL-coating“) oder als direkte Beladung des optischen Materials mit einem Arzneimittel („IOL-soaking“). Eine weitere Möglichkeit besteht in der Befestigung eines Medikamententrägers an der Haptik („IOL-haptic-modification“). Bei dieser Variante würde das Material der IOL-Optik unbeeinflusst bleiben. Zahlreiche therapeutische Ziele und Einsatzmöglichkeiten einer pharmakologisch modifizierten IOL sind denkbar. Deshalb müssen unterschiedliche pharmakologische Wirkstoffklassen zunächst in vitro und in vivo auf ihre Sicherheit und Wirksamkeit untersucht werden. Welche Wirkstoffe tatsächlich für eine IOL-Modifikation geeignet und wirksam sind, ist Gegenstand präklinischer und klinischer Studien. In diesem Artikel geben wir eine Übersicht über die bisherigen wissenschaftlichen Entwicklungen und befassen uns mit zukünftigen Einsatzmöglichkeiten einer pharmakologisch modifizierten Intraokularlinse in der Kataraktchirurgie, wie z. B. mit einer mit Erufosin beladenen IOL zur pharmakologischen Nachstarprophylaxe, einer mit Heparin beladenen IOL zur Linderung des intraokularen Reizzustands nach Kataraktoperation oder mit einer mit Cefuroxim beladenen IOL zur Endophthalmitisprophylaxe.

Abstract

Development of an intraocular lens (IOL) as a drug delivery device has been pursued for many years and is a promising concept in modern cataract surgery. Common postoperative conditions such as posterior capsule opacification (PCO), intraocular inflammation or the rare but severe complications of cataract surgery like endophthalmitis are potential therapeutic targets for a drug-eluting IOL. There are three techniques of pharmacological IOL modification: Firstly, surface modification of the IOL (“coating”); secondly, IOL optic modification (“soaking”) and lastly, loading the IOL haptics with a slow release system. The last option does not interfere with the IOL optics at all. Therefore, a broad spectrum of pharmacological agents needs to be assessed in preclinical and clinical studies to determine which agent/IOL combination is safe and efficient. For pharmacological PCO prophylaxis, erufosine-loaded IOLs are of great clinical interest. Heparin-coated IOLs might become clinically relevant for attenuation of intraocular inflammation after cataract surgery and cefuroxime-loaded IOLs for endophthalmitis prophylaxis.

Schlüsselwörter

Katarakt - intraokulare Entzündungen - Pharmakologie - Intraokularlinse - Medikamententräger - Kataraktchirurgie - Nachstar - Reizzustand - Endophthalmitis

Key words

cataract - pharmacology - intraocular lens - drug delivery - cataract surgery - posterior capsule opacification - intraocular inflammation - endophthalmitis

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