Abb. 8.48 Diabetisches Makulaödem mit deutlich traktiver Komponente. Hier kann eine ppV mit ILM Peeling zu einer Ödemreduktion führen

mit oder ohne ILM-Peeling bislang selektierten Patienten vorbehalten.

8Fazit für die Praxis

Das diabetische Makulaödem bleibt die häufigste Ursache für eine Visusminderung.

Während die Lasertherapie noch ein Goldstandard ist, ist seit Januar 2011 die Anti-VEGF-Therapie zur Behandlung des DMÖ zugelassen. Verschiedenste Studien konnten die Effektivität der intravitrealen Injektion mit einer alleinigen Anti-VEGF-Therapie oder in Kombination mit dem Laser zeigen, wobei sich eine Überlegenheit der Anti-VEGF-Therapie gegenüber der Lasertherapie darstellt. Auch Steroide können das Makulaödem signifikant verringern. Vergleichsstudien zeigen eine ähnliche Wirksamkeit in den ersten 6 Therapiemonaten, jedoch führt die Steroidgabe zu einer progredienten Kataraktbildung und zum Steroidglaukom. Weitere Studien müssen folgen, um diese Ergebnisse zu bestätigen und die Langzeitprognose abzuschätzen. Ziel künftiger Studien

muss darüber hinaus auch die Untersuchung der Wirksamkeit in Untergruppen, wie bei Patienten mit ischämischen DMÖ, sein. Ebenso müssen Therapiekonzepte im Zusammenhang mit einer optimierten Blutzuckereinstellung erstellt werden.

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