450 Kapitel 17 · Vaskuläre Tumoren der Netzhaut

Unbehandelt führen VTR zu einer zunehmenden exsudativen Netzhautablösung mit Visusverlust und Sekundärglaukom, sodass VTR spätestens bei Auftreten einer Symptomatik behandelt werden sollten. Lokale Behandlungsmethoden stehen dabei im Vordergrund. Kleine Tumoren können mit transkonjunktivaler Kryotherapie effektiv behandelt werden. Wegen der weißlichen Struktur der Tumoren ist eine Laserkoagulation in der Regel weniger effektiv. Die photodynamische Therapie mit Verteporfin ist nur in Einzelfällen beschrieben worden, da aufgrund der eher geringen Vaskularisation der VTR eine eingeschränkte Wirksamkeit zu erwarten ist. Bei größeren Tumoren kann die Brachytherapie die Zerstörung des Tumors mit Erhalt der zentralen Netzhautfunktion erreichen. Beta-Applikatoren (106Ru/106Rh) sind dabei wegen der günstigeren Dosisverteilung anderen Strahlenquellen wie Gamma-Applikatoren vorzuziehen ( Abb. 17.24).

Die Therapie mit VEGF-Inhibitoren kann die tumorbedingte Leckage reduzieren. Das Tumorvolumen nimmt ebenfalls ab, sodass auch größere Tumoren dann einer Kryotherapie zugänglich gemacht werden können. Die Injektion der VEGF-Inhibitoren muss ggf. repetitiv erfolgen, die anschließende tumordestruktive Therapie sollte im Intervall erfolgen. Die Therapie mit VEGF-Inhibi- toren kann nicht als kausal angesehen werden, sondern führt lediglich zu einer symptomatischen Reduktion der Leckage der pathologischen Gefäße ( Abb. 17.25). Additiv sind eine Kryotherapie bei kleinem Tumorvolumen oder eine Bestrahlung mittels Brachytherapie notwendig.

Fazit für die Praxis

Vasoproliferative Tumoren der Retina (VTR) sind selten und müssen insbesondere von kapillaren Hämangiomen, z.B. im Rahmen eines von Hippel-Lindau-Syndroms, abgegrenzt werden. In der Regel ist eine (lokale) Behandlung notwendig, da VTR unbehandelt zu visusbedrohenden Komplikationen, wie insbesondere massiven subretinalen Exsudaten und sekundären Netzhautablösungen führen können.

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