Therapie der okulären Graft-versus-Host-Erkrankung

Zusammenfassung

Die Therapie der okulären Graft-versus-Host Erkrankung (GvHD) stellt behandelnde Augenärzte häufig vor große Herausforderungen, da die Erkrankung oft rapide und nur schwer vorhersehbar verläuft. Primäres Therapieziel ist die Erhaltung oder Wiederherstellung des Sehvermögens, wobei aktuell nur wenige Studien zur Wirksamkeit der unterschiedlichen Verfahren verfügbar sind und zumeist Daten aus Studien zum Trockenen Auge mit anderen Ursachen vorliegen. Der Übersichtsartikel stellt die grundsätzlich verfügbaren Therapieansätze gegliedert nach lokaler, systemischer, operativer und prophylaktischer Option inklusive aktueller GvHD-Studien dar. Insgesamt existieren diverse lokale Therapien (Tränenersatzmittel, topisches Ciclosporin A etc.), systemische Verfahren (Immunsuppression, Photopherese etc.) und operative Maßnahmen, um die okuläre GvHD zu behandeln. Haupttherapieziele sind die Entzündungshemmung, die Antifibrose und die Oberflächenlubrikation. Obwohl in Konsensuskonferenzen Therapien empfohlen werden, sind Studien speziell zur GvHD unbedingt erforderlich, damit in Zukunft eine stadiengerechte Behandlung evidenzbasiert vorgenommen werden kann.

Abstract

Therapy for ocular graft-vs-host disease (ocular GvHD) is challenging for ophthalmologists as progress of the disease often occurs rapidly and is unforeseeable. Primary goal is the preservation or restoration of visual acuity, however, studies on ocular GvHD that have investigated therapeutic concepts are limited. In contrast, most therapeutic recommendations from consensus conferences derive from studies on dry eye diseases other than ocular GvHD. This review demonstrates the available therapies in the following categories: local, systemic, surgical and prophylactic. Primary targets are anti-inflammation, anti-fibrosis and lubrification of the ocular surface. In conclusion, studies strictly on ocular GvHD are needed to enable better evidence-based therapeutic decision-making in the future.

Schlüsselwörter

Bindehaut - Kornea - Kontaktlinsen - okuläre Graft-versus-Host Erkrankung (GvHD) - Serumaugentropfen

Key words

conjunctiva - contact lenses - cornea - ocular graft-vs-host disease (ocular GvHD) - serum eyedrops

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