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Klin Monbl Augenheilkd 2018; 235(07): 830-839
DOI: 10.1055/s-0043-106302
DOI: 10.1055/s-0043-106302
Übersicht
Retinale Gefäßverschlüsse: Moderne Therapieansätze
Retinal Vascular Occlusion: Modern Therapeutic ApproachesFurther Information
Publication History
eingereicht 17 January 2017
akzeptiert 05 March 2017
Publication Date:
27 July 2017 (online)
Zusammenfassung
Arterielle Gefäßverschlüsse sollten als Notfall bewertet werden und sind als okuläres Analogon zum zerebralen Apoplex zu sehen. Sie besitzen dieselben arteriosklerotischen Risikofaktoren, die auch bei Herz-, Kreislauf- und zerebrovaskulären Erkrankungen ursächlich sind, weshalb eine intensive interdisziplinäre Abklärung erforderlich ist, um mögliche Komorbiditäten rechtzeitig zu erkennen und gegebenenfalls zu behandeln. Die derzeitigen Therapiemöglichkeiten eines akuten arteriellen Gefäßverschlusses sind in ihrer Effizienz hinsichtlich Visusverbesserung sehr limitiert. Verfahren zur systemischen Lyse können in der Routineversorgung aufgrund ihres deutlich erhöhten Nebenwirkungsprofils nicht empfohlen werden. Hinzu kommt ein begrenztes Zeitfenster von bis zu 6 Stunden nach Symptombeginn (Retinatoleranzzeit), in dem nach Studienlage eine Intervention überhaupt nur sinnvoll zu sein scheint. Dagegen haben die neuen Therapiemöglichkeiten retinaler Venenverschlüsse, insbesondere durch die intravitreale operative Medikamentenapplikation, zu deutlichen Visusverbesserungen geführt. Die Wirksamkeit und Effizienz der einzelnen Anti-VEGF-Medikamente ist nach aktueller Studienlage vergleichbar. Alternativ kann auch der Einsatz von Steroiden erwogen werden, wobei hierbei das Nebenwirkungsprofil sorgfältig abgewogen werden sollte. Des Weiteren kann ergänzend und gerade beim Vorliegen von retinalen Ischämien die periphere Photolaserkoagulation einen visusstabilisierenden Effekt haben und die Ausbildung von Neovaskularisationen verhindern. Es wird angenommen, dass die Kombination aus IVOM- und Lasertherapie einen symbiotischen Effekt haben könnte.
Abstract
Retinal artery occlusion (RAO) should be evaluated as an emergency and can be seen as an ocular analogue to the cerebral apoplex. Both have the same arteriosclerotic risk factors, which are also responsible for cardiac, circulatory and cerebrovascular diseases. That is why an intensive interdisciplinary clarification is necessary to recognize possible comorbidities in time and, if necessary, to treat them. The current therapeutic possibilities of an acute RAO are very limited in their efficiency regarding visual improvement. Methods for systemic lysis cannot be recommended in routine care because of their significantly increased side-effect profile. However, there is a limited window of time of up to 6 hours after the onset of symptoms in which an intervention appears to be useful at all. On the other hand, the new therapeutic possibilities of retinal vein occlusions (RVO) led to marked visual improvements, especially due to the intravitreal application of anti-VEGF. Safety and efficiency of the individual anti-VEGF drugs are comparable according to clinical trials. Alternatively, the use of intravitreal steroids can be considered, whereby the side-effect profile should be carefully weighed. In the presence of retinal ischaemia, peripheral laser coagulation can have a stabilizing effect on visual acuity and prevents neovascularization. It is postulated that the combination of anti-VEGF and laser therapy might have a symbiotic effect.
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