Zusammenfassung
Das Auge ist im Vergleich zu anderen Organen vermehrt gefährdet, oxidative Schäden zu erleiden. Ursache hierfür ist u. a. die lebenslange Lichteinwirkung. Die Strukturen des vorderen Augenabschnittes sind v. a. einer UV-Einwirkung ausgesetzt, während bei der Netzhaut der blaue Anteil des sichtbaren Spektrums eine wichtige Rolle spielen soll. Die biochemische Zusammensetzung der okulären Strukturen ist ein weiterer Faktor, der diese im Vergleich zu anderen Organen vermehrte oxidative Gefährdung ausmacht. Bei ischämischen Netzhauterkrankungen spielen die von anderen Organen bekannten Mechanismen wie z. B. die Xanthinoxidasereaktion die Hauptrolle. Ischämische Prozesse gelten bei der diabetischen Retinopathie im Hinblick auf die Generierung oxidativer Metaboliten mittlerweile eher als Sekundärreaktionen. Hier stehen heute Glykosylierungsprodukte (AGEs) und die auch oxidativ induzierbare Expression von Wachstumsfaktoren im Mittelpunkt. Bei der altersbedingten Makuladegeneration scheinen photodynamische Prozesse (v. a. Typ-2-Reaktion), die von Kindheit an ablaufen und auch durch sichtbares, v. a. blaues Licht, unterhalten werden, mitverantwortlich für die Entstehung des Krankheitsbildes zu sein. Zusätzlich kann die Induktion des Gefäßwachstums bzw. die Expression von Wachstumsfaktoren über Entzündungsreaktionen, aber auch oxidativ erfolgen. Ziel dieser Übersichtsarbeit ist es, einen Überblick über verschiedene bei Netzhauterkrankungen beteiligte oxidative Mechanismen zu geben und mögliche Therapie- und Präventionsansätze aufzuzeigen. Diese Ansätze, wie z. B. die Ergebnisse der ARED-Studie, werden auch unter Berücksichtigung des Nebenwirkungsprofils diskutiert.
Abstract
The eye is at high risk to be damaged by oxidative mechanisms. One major reason is the exposure to light throughout life. Anterior segment structures are mostly exposed to UV light. Visible blue light is believed to be a significant damaging mechanism for the retina. The biochemical composition of the posterior segment structures (unsaturated fatty acids) is an important factor making the eye more susceptible than other organs. Damaging mechanisms such as xanthin oxidase mechanisms are responsible for damage occurring in ischaemic diseases. These mechanisms are well known from diseases of other organs. Ischaemic processes are no longer believed to be the primary damaging mechanisms in diabetic retinopathy. Here, advanced glycation end products (AGE's) and related products may induce oxidative reactions and the expression of growth factors. In age-related macular degeneration photodynamic processes occurring already in childhood are believed to be a major factor contributing to the pathogenesis of the disease process. In addition, the expression of growth factors and new vessel growth can be initiated via inflammatory reactions or oxidative metabolites. In this manuscript we give an overview on oxidative mechanisms involved in the pathogenesis of retinal diseases. Different therapeutical and preventive approaches such as the results of the ARED-Study and possible side effects are discussed.
Schlüsselwörter
Oxidative Metaboliten - Netzhaut - Diabetes - altersbedingte Makuladegeneration (AMD)
Key words
Oxidative metabolites - retina - diabetes - age-related macular degeneration (AMD)
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Albert J. Augustin
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