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Klin Monbl Augenheilkd 2018; 235(05): 586-591
DOI: 10.1055/a-0590-4546
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Topische Kortikosteroide und nicht steroidale Antiphlogistika zur Behandlung der nicht infektiösen Uveitis

Topical Corticosteroids and Non-steroidal Anti-inflammatory Drugs in the Therapy of Non-infectious Uveitis
Deshka Doycheva
1   Department für Augenheilkunde, Eberhard-Karls-Universität Tübingen
,
Christoph Deuter
1   Department für Augenheilkunde, Eberhard-Karls-Universität Tübingen
,
Rafael Grajewski
2   Zentrum für Augenheilkunde, Universität zu Köln
› Author Affiliations
Further Information

Publication History

eingereicht 27 February 2018

akzeptiert 09 March 2018

Publication Date:
08 May 2018 (online)

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Zusammenfassung

Topische Kortikosteroide sind effektive entzündungshemmende Medikamente in der Therapie der anterioren Uveitis. Die intraokulare Effektivität der topischen Steroide ist überwiegend durch ihre Penetrationsfähigkeit ins Auge limitiert. Lipophile Präparate wie Dexamethason oder Prednisolonacetat penetrieren besser in die Vorderkammer als hydrophile. Prednisolonacetat 1% ist das Mittel der Wahl in der Behandlung von Patienten mit anteriorer Uveitis. Loteprednol und Fluorometholon besitzen eine schwächere antientzündliche Wirkung, beeinflussen aber weniger den Augeninnendruck und sind deswegen hilfreich bei Patienten mit Steroidresponse. Die antientzündliche Therapie mit lokalen Steroiden muss individuell angepasst werden in Abhängigkeit von Verlauf und Schweregrad der Uveitis. Die häufigsten unerwünschten Wirkungen der lokalen Kortisontherapie sind das steroidinduzierte Glaukom und die Katarakt. Nicht steroidale Antiphlogistika hemmen das Enzym Zyklooxygenase, das für die Bildung proinflammatorischer Prostaglandine zuständig ist. Sie haben eine ergänzende Rolle bei der Behandlung und Vorbeugung postoperativer Reizzustände nach Kataraktoperation. Eine therapeutische Rolle in der Behandlung der Uveitis und des zystoiden Makulaödems sekundär nach Uveitis konnte bisher nicht etabliert werden.

Abstract

Topical corticosteroids are effective anti-inflammatory drugs in the treatment of anterior uveitis. The intraocular efficacy of topical corticosteroids mostly depends on their intraocular permeability through the cornea. Lipophile derivatives such as dexamethasone and prednisolone acetate penetrate better into the anterior chamber than hydrophilic derivatives. Prednisolone acetate 1% is the first choice in the therapy of patients with anterior uveitis. Loteprednole and fluorometholone have a slightly weaker anti-inflammatory effect, but they induce less elevation of intraocular pressure and might be helpful in the treatment of patients with steroid response. Topical corticosteroid therapy has to be individually adapted, depending on the clinical course and severity of uveitis. The most common side effects of topical corticosteroids are corticosteroid-induced glaucoma and corticosteroid-induced cataracts. Non-steroidal anti-inflammatory drugs inhibit the enzyme cyclooxygenase that is responsible for the formation of pro-inflammatory prostaglandins. These have an adjunctive role in the treatment and prevention of post-operative inflammation after cataract surgery. A therapeutic role of topical NSAID to treat uveitis and cystoid macular oedema secondary to uveitis has not yet been established.

Schlüsselwörter

intraokulare Entzündungen - Pharmakologie - Mikrobiologie

Key words

intraocular inflammation - pharmacology - microbiology
 

  • Literatur

  • 1 Gordon DM, McLean JM. Effects of pituitary adrenocorticotropic hormone (ACTH) therapy in ophthalmologic conditions. JAMA 1950; 142: 1271-1276
    CrossrefPubMedSearch in Google Scholar
  • 2 Nussenblatt RB, Whitcup SM. Uveitis: Fundamentals and clinical Practice. St. Louis: Mosby; 1996
    Search in Google Scholar
  • 3 McGhee CN, Dean S, Danesh-Meyer H. Locally administered ocular corticosteroids. Drug Saf 2002; 25: 33-55
    CrossrefPubMedSearch in Google Scholar
  • 4 McGhee CNJ. Pharmacokinetics of ophthalmic corticosteroids. Br J Ophthalmol 1992; 76: 681-684
    CrossrefPubMedSearch in Google Scholar
  • 5 Taylor SRJ, Isa H, Joshi L. et al. New developments in corticosteroid therapy for uveitis. Ophthalmologica 2010; 224: 46-53
    CrossrefPubMedSearch in Google Scholar
  • 6 McGhee CN, Noble MJ, Watson DG. et al. Penetration of topically applied prednisolone sodium phosphate into human aqueous humour. Eye (Lond) 1989; 3: 463-467
    CrossrefPubMedSearch in Google Scholar
  • 7 Green K, Downs SJ. Prednisolone phosphate penetration into and through the cornea. Invest Ophthalmol 1974; 13: 316-318
    PubMedSearch in Google Scholar
  • 8 Kupferman A, Pratt MV, Suckewer K. et al. Topically applied steroids in corneal disease. III. The role of drug derivative in stromal absorption of dexamethasone. Arch Ophthalmol 1974; 91: 312-314
    PubMedSearch in Google Scholar
  • 9 Kupferman A, Leibowitz HM. Topically applied steroids in corneal disease. IV. The role of drug concentration in stromal absorption of prednisolone acetate. Arch Ophthalmol 1974; 91: 377-380
    CrossrefPubMedSearch in Google Scholar
  • 10 Leibowitz HM, Kupferman A. Kinetics of topically administered prednisolone acetate. Arch Ophthalmol 1976; 94: 1387-1389
    CrossrefPubMedSearch in Google Scholar
  • 11 McGhee CN, Watson DG, Midgley JM. et al. Penetration of synthetic corticosteroids into human aqueous humour. Eye (Lond) 1990; 4: 526-530
    CrossrefPubMedSearch in Google Scholar
  • 12 Watson DG, McGhee CN, Midgley JM. et al. Penetration of topically applied betamethasone sodium phosphate into human aqueous humour. Eye (Lond) 1990; 4: 603-606
    CrossrefPubMedSearch in Google Scholar
  • 13 Krupin T, Waltman ST, Becker B. Ocular penetration in rabbits of topically applied dexamethasone. Arch Ophthalmol 1974; 92: 312-314
    CrossrefPubMedSearch in Google Scholar
  • 14 Leibowitz HM, Kupferman A. Anti-inflammatory effectiveness in the cornea of topically administered prednisolone. Invest Ophthalmol 1974; 13: 757-761
    PubMedSearch in Google Scholar
  • 15 Kupferman A, Berrospi AR, Leibowitz HM. Fluorometholone acetate. A new ophthalmic derivative of fluorometholone. Arch Ophthalmol 1982; 100: 640-641
    CrossrefPubMedSearch in Google Scholar
  • 16 Gaudio PA. A review of evidence guiding the use of corticosteroids in the treatment of intraocular inflammation. Ocul Immunol Inflamm 2004; 12: 169-192
    CrossrefPubMedSearch in Google Scholar
  • 17 Dunne JA, Travers JP. Double-blind clinical trial of topical steroids in anterior uveitis. Br J Ophthalmol 1979; 63: 762-767
    CrossrefPubMedSearch in Google Scholar
  • 18 Awan MA, Agarwal PK, Watson DG. et al. Penetration of topical and subconjunctival corticosteroids into human aqueous humour and its therapeutic significance. Br J Ophthalmol 2009; 93: 708-713
    CrossrefPubMedSearch in Google Scholar
  • 19 [Anonymous] Controlled evaluation of loteprednol etabonate and prednisolone acetate in the treatment of acute anterior uveitis. Loteprednol Etabonate US Uveitis Study Group. Am J Ophthalmol 1999; 127: 537-544
    CrossrefPubMedSearch in Google Scholar
  • 20 Foster CS, Alter G, DeBarge R. et al. Efficacy and safety of rimexolone 1 % ophthalmic suspension vs. 1 % prednisolone acetate in the treatment of uveitis. Am J Ophthalmol 1996; 122: 171-182
    CrossrefPubMedSearch in Google Scholar
  • 21 Foster CS, Davanzo R, Flynn TE. et al. Durezol (Difluprednate Ophthalmic Emulsion 0.05 %) compared with Pred Forte 1 % ophthalmic suspension in the treatment of endogenous anterior uveitis. J Ocul Pharmacol Ther 2010; 26: 475-483
    CrossrefPubMedSearch in Google Scholar
  • 22 Slabaugh MA, Herlihy E, Ongchin S. et al. Efficacy and potential complications of difluprednate use for pediatric uveitis. Am J Ophthalmol 2012; 153: 932-938
    CrossrefPubMedSearch in Google Scholar
  • 23 Hedayatfar A, Hashemi H, Asgari S. et al. Comparison of efficacy and ocular surface toxicity of topical preservative-free methylprednisolone and preserved prednisolone in the treatment of acute anterior uveitis. Cornea 2014; 33: 366-372
    CrossrefPubMedSearch in Google Scholar
  • 24 Leibowitz HM, Kupferman A. Optimal frequency of topical prednisolone administration. Arch Ophthalmol 1979; 97: 2154-2156
    CrossrefPubMedSearch in Google Scholar
  • 25 Heiligenhaus A, Minden K, Tappeiner C. et al. Interdisziplinäre Leitlinie zur Diagnostik und antientzündlichen Therapie der Uveitis bei juveniler idiopathischer Arthritis. AWMF-Register Nr. 045/012. Im Internet: http://www.awmf.org/leitlinien/detail/ll/045-012.html Stand: 16.01.2018
    PubMedSearch in Google Scholar
  • 26 Armaly MF. Inheritance of dexamethasone hypertension and glaucoma. Arch Ophthalmol 1967; 77: 747-751
    CrossrefPubMedSearch in Google Scholar
  • 27 Armaly MF. Effect of corticosteroids on intraocular pressure and fluid dynamics: 2. The effect of dexamethasone in the glaucomatous eye. Arch Ophthalmol 1963; 70: 492-499
    CrossrefPubMedSearch in Google Scholar
  • 28 Johnson D, Gottanka J, Flügel C. et al. Ultrastructural changes in the trabecular meshwork of human eyes treated with corticosteroids. Arch Ophthalmol 1997; 115: 375-383
    CrossrefPubMedSearch in Google Scholar
  • 29 Black RL, Oglesby RB, von Sallmann L. et al. Posterior subcapsular cataracts induced by corticosteroids in patients with rheumatoid arthritis. JAMA 1960; 174: 166-171
    CrossrefPubMedSearch in Google Scholar
  • 30 Dickerson jr. JE, Dotzel E, Clark AF. Steroid-induced cataract: new perspective from in vitro and lens culture studies. Exp Eye Res 1997; 65: 507-516
    CrossrefPubMedSearch in Google Scholar
  • 31 Tamada Y, Miyashita H, Ono S. Studies on phospholipid metabolism of rabbit lens with special references to long-term topical administration of steroid. Jpn J Ophthalmol 1980; 24: 289-296
    PubMedSearch in Google Scholar
  • 32 Thorne JE, Woreta FA, Dunn JP. et al. Risk of cataract development among children with juvenile idiopathic arthritis-related uveitis treated with topical corticosteroids. Ophthalmology 2013; 54: 1280-1287
    PubMedSearch in Google Scholar
  • 33 Kothari S, Foster CS, Pistilli M. et al. The risk of intraocular pressure elevation in pediatric non-infectious uveitis. Ophthalmology 2015; 122: 1987-2001
    CrossrefPubMedSearch in Google Scholar
  • 34 Romano PE, Traisman HS, Green OC. Fluorinated corticosteroid toxicity in infants. Am J Ophthalmol 1977; 84: 247-250
    CrossrefPubMedSearch in Google Scholar
  • 35 Anderson JA, Chen CC, Vita JB. et al. Disposition of topical flurbiprofen in normal and aphakic rabbit eyes. Arch Ophthalmol 1982; 100: 642-645
    CrossrefPubMedSearch in Google Scholar
  • 36 Ling TL, Combs DL. Ocular bioavailability and tissue distribution of [14C]ketorolac tromethamine in rabbits. J Pharm Sci 1987; 76: 289-294
    CrossrefPubMedSearch in Google Scholar
  • 37 Dunne JA, Jacobs N, Morrison A. et al. Efficacy in anterior uveitis of two known steroids and topical tolmetin. Br J Ophthalmol 1985; 69: 120-125
    CrossrefPubMedSearch in Google Scholar
  • 38 Teasley LA, Christen WG, Foster CS. Oral nonsteroidal anti-inflammatory agents in the treatment of chronic or recurrent noninfectious uveitis. Contempor Ophthalmol 2007; 6: 1-6
    PubMedSearch in Google Scholar
  • 39 Bauer AM, Fiehn C, Becker MD. Celecoxib, a selective inhibitor of cyclooxygenase 2 for therapy of diffuse anterior scleritis. Am J Ophthalmol 2005; 139: 1086-1089
    CrossrefPubMedSearch in Google Scholar
  • 40 Hakin KN, Watson PG. Systemic associations of scleritis. Int Ophthalmol Clin 1991; 31: 111-129
    CrossrefPubMedSearch in Google Scholar
  • 41 Colin J. The role of NSAIDs in the management of postoperative ophthalmic inflammation. Drugs 2007; 67: 1291-1308
    CrossrefPubMedSearch in Google Scholar
  • 42 Diestelhorst M, Schmidl B, Konen W. et al. Efficacy and tolerance of diclofenac sodium 0.1 %, flurbiprofen 0.03 %, and indomethacin 1.0 % in controlling postoperative inflammation. J Cataract Refract Surg 1996; 22 (Suppl. 01) S788-S793
    CrossrefPubMedSearch in Google Scholar
  • 43 Thaller VT, Kulshrestha MK, Bell K. The effect of pre-operative topical flurbiprofen or diclofenac on pupil dilatation. Eye (Lond) 2000; 14: 642-645
    CrossrefPubMedSearch in Google Scholar
  • 44 Sivaprasad S, Bunce C, Wormald R. Non-steroidal anti-inflammatory agents for cystoid macular oedema following cataract surgery: a systematic review. Br J Ophthalmol 2005; 89: 1420-1422
    CrossrefPubMedSearch in Google Scholar