Zusammenfassung
Hintergrund: Das Spektrum der Behandlungsmöglichkeiten choroidaler Neovaskularisationen hat durch die Einführung der photodynamischen Therapie eine wesentliche Bereicherung erfahren. Der umfangreiche technische und finanzielle Aufwand, der mit dieser Methode verbunden ist, erfordert aber einen gezielten und konsequenten Einsatz, um einerseits entsprechende Behandlungserfolge zu erzielen und andererseits die Grenzen der vorhandenen Ressourcen nicht zu überschreiten. Dieser gezielte Einsatz ist nur dann möglich, wenn die Grundlagen der Diagnose, der Indikationsstellung, der Behandlung und der Nachbetreuung ausreichend bekannt sind und entsprechend angewendet werden. Material, Methoden und Resultate: Die Standardtherapie, bisher darüber publizierte Studien und klinische Erfahrungsberichte werden im Überblick präsentiert und kritisch kommentiert. Schlussfolgerungen: Die photodynamische Therapie mit Verteporfin kann zwar in vielen Fällen einen massiven Visusverlust verhindern, die Ergebnisse sind aber je nach Grundkrankheit sehr unterschiedlich. Eine photodynamische Therapie sollte daher nur nach strenger Indikationsstellung erfolgen. Kombinationen mit anderen medikamentösen Therapien und Anpassungen der Behandlungsparameter werden vielleicht in Zukunft die Behandlungsergebnisse verbessern.
Abstract
Background: The spectrum of possible treatments for choroidal neovascularisation has been considerably increased with the introduction of photodynamic therapy. On the other hand the technical complexity and high cost associated with this new method require a pinpointed and dedicated application to achieve not only treatment benefits for the patients, but also not to exceed the available resources. This focussed application of the new treatment method can only be performed if the basics of diagnosis, indication, treatment and follow-up care are sufficiently known and used. Material, methods and results: The standard treatment protocol, the results of published clinical trials as well as many published clinical observations are presented and discussed. Conclusions: Photodynamic therapy with verteporfin can prevent massive loss of vision in many cases of subfoveal choroidal neovascularisation, but the treatment outcome depends on many factors, the most important being the underlying disease process. Hence, indication for photodynamic therapy should adhere to the published treatment guidelines. In the future, additional medications or alterations of the treatment protocol might improve treatment outcome.
Schlüsselwörter
Altersbedingte Makuladegeneration - Chorioretinopathia centralis serosa - choroidale Neovaskularisation - Aderhauthämangiom - Fluoreszenzangiographie - optische Kohärenztomographie - photodynamische Therapie - Verteporfin
Key words
Age-related macular degeneration - central serous chorioretinopathy - choroidal neovascularisation - choroidal haemangioma - fluorescein angiography - optical coherence tomography - photodynamic therapy - verteporfin
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