Stand der TTT bei der Therapie der CNV

Zusammenfassung

Die transpupillare Thermotherapie (TTT) und photodynamische Therapie (PDT) sind neue Verfahren zur Behandlung choroidaler Neovaskularisationen. Während bei der PDT über die Injektion eines photosensibilisierenden Stoffes eine photochemische Reaktion erzeugt wird, stellt die TTT eine nichtinvasive photothermische Behandlungsform von sowohl choroidalen Neovaskularisationen (CNV) als auch choroidalen Tumoren dar. Hierbei kommt es zu einer geringen Erwärmung des Gewebes, wodurch metabolische Prozesse unter anderem durch die Induktion von Hitzeschockproteinen ausgelöst werden, was zur Wiederherstellung der Zellhomöostase führen kann. Die Laserkoagulation, die von der Macular Photocoagulation Study Group empfohlen wird, birgt aufgrund ihrer photokoagulativen Wirkung mit deutlicher Gewebserwärmung den Nachteil eines sofort nach der Behandlung stattfindenden Sehverlusts. Für die Behandlung der klassischen CNV ist die PDT eine etablierte Therapieform. Positive Ergebnisse der PDT bei der Therapie der okkulten CNV führten ebenfalls zur Anwendung der PDT bei dieser Unterform unter bestimmten Bedingungen. Die TTT stellt eine kostengünstigere Therapieform bei CNV dar. Der Effekt auf die Visusstabilisierung bei (vorwiegend) okkulten CNV wird relativ unterschiedlich bewertet, eine Übersicht gibt [Tab. 1].

Abstract

Transpupillary thermotherapy (TTT) and photodynamic therapy (PDT) are recent treatment options for choroidal neovascularisation (CNV). In PDT a photochemical reaction is induced by the injection of a photosensitising substance. In contrast to this, TTT is a non-invasive photothermal treatment option for CNV and choroidal tumours. It leads to a low-grade-hyperthermia with consecutive induction of metabolic processes and production of heat-shock proteins in order to restore cellular homeostasis. Classical laser coagulation as recommended by the Macular Photocoagulation Study Group produces a photocoagulative effect with significant tissue hyperthermia and prompt visual loss. For classic CNV, PDT represents an established therapy option. Positive results of the treatment of occult CNV by PDT have enlarged the use of PDT to this kind of CNV. TTT represents an economic therapy modality for (mainly) occult CNV. The effect for visual outcome varies in different studies. The results are shown in a [Table 1].

Schlüsselwörter

choroidale Neovaskularisation - transpupillare Thermotherapie - Low-grade-Hyperthermie - Hitzeschockproteine

Key words

choroidal neovascularisation - transpupillary thermotherapy - low-grade hyperthermia - heat-shock proteins

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