138 Kapitel 8 · Geographische Atrophie

erste Phase-III-Studie bei GA dar. Als besonderer Vorteil zur Beurteilung von Therapieeffekten erscheint, dass die individuelle Progressionsrate für die meisten Patienten in der vorher durchgeführten GAP-Studie – eine Beobachtungsstudie über 18 Monate – erfasst wurde. Die Fundu- sautofluoreszenz-Aufnahmen aus den 51 teilnehmenden Zentren werden im GRADE-Reading Center der Bonner Universitäts-Augenklinik ausgewertet.

Fazit

▬Studien zum natürlichen Verlauf der geographischen Atrophie konnten mehrere prädiktive (okuläre) Marker für die GA-Progression identifizieren

▬Bislang konnten keine endogenen, systemischen Faktoren identifiziert werden, die mit einer erhöhten GAProgressionsrate assoziiert sind.

▬Prognostische Marker sind insbesondere hilfreich zur Pla-

nung interventioneller Studien. Der Einschluss von »fast progressers« kann die Fallzahl und Studiendauer und

8damit auch Kosten reduzieren.

▬Die Fundusautofluoreszenz-Bildgebung gilt als »Goldstandard« für die Bildgebung bei geographischer Atrophie. Insbesondere gelingt hiermit die Identifikation von Atrophiearealen, die präzise Quantifikation der Progression sowie die Detektion von Mustern erhöhter Fundusautofluoreszenz im Randbereich der Atrophie, die einen signifikanten Einfluss auf die Progressionsrate haben.

▬Die Einschätzung der Sehfunktion bei Patienten mit geographischer Atrophie stellt eine Herausforderung dar, da, trotz guter Sehschärfe bei Aussparung der Fovea auch über längere Zeit, eine erhebliche Einschränkung beim Lesen und des Sehens in gedimmtem Licht vorliegen kann.

▬Neue bildgebende Technologien mit kombinierter konfokaler Scanning-Laserophthalmoskopie und Spectral-Do- main-OCT ermöglichen eine Zuordnung pathologischer Befunde in quasi histologischen Schnitten in vivo. In Zukunft können somit neue Erkenntnisse über Pathogenese und Progression der geographischen Atrophie erlangt werden.

▬Zahlreiche präklinische und klinische Entwicklungen pharmakologischer Interventionen adressieren unterschiedliche »pathways« der komplexen, multifaktoriellen GA. Perspektivisch käme bei Wirksamkeitsnachweis im Rahmen der GA auch ein Einsatz bei der frühen, trockenen AMD in Frage.

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