Stellenwert der optischen Kohärenztomografie-Angiografie bei neuroophthalmologischen Erkrankungen

Zusammenfassung

Die optische Kohärenztomografie-Angiografie (OCTA) ist eine der am intensivsten untersuchten Neuentwicklungen in der bildgebenden Ophthalmologie der letzten Jahre. Dabei fand diese nicht invasive Bildgebung von retinalem, chorioidalem und peripapillärem Blutfluss initial Anklang in der Retinologie und neuerdings auch zunehmend Beachtung in der neuroophthalmologischen Diagnostik. Besonderes Interesse wurde auf Erkrankungen gelegt, bei denen eine vaskuläre Pathogenese diskutiert wird, wie die nicht arteriitische und die arteriitische anteriore ischämische Optikusneuropathie (NAION und AAION). Zahlreiche Studien demonstrierten eine Rarefizierung des peripapillären Gefäßnetzes und einen reduzierten Blutfluss in NAION- und in AAION-Patienten im Vergleich zu gesunden Patienten. Dabei korreliert das Ausmaß des Gefäßschadens mit der Schwere der Optikusatrophie. Ähnliche Ergebnisse treffen auch für Optikusatrophien anderer Ursachen zu (z. B. Drusenpapille, hereditäre Optikusatrophien usw.). Die genauen Kausalzusammenhänge zwischen Optikusneuropathie und Blutflussminderung bleiben vorerst jedoch unklar und müssen in zukünftigen Untersuchungen adressiert werden. Bei einigen Erkrankungen scheint die OCTA auch von differenzialdiagnostischem Wert zu sein. Bei Hämangioblastomen lieferte sie besonders bei großen und breitbasigen Befunden relevante Mehrinformationen im Vergleich zur Fluoreszenzangiografie und kann die hämangioblastomtypischen Gefäßnetze und die zuführenden Gefäße darstellen. Diese Übersicht fasst die neuen Informationen der OCTA-Studien zu neuroophthalmologischen Erkrankungen zusammen und hinterfragt diese bez. Relevanz und Mehrwert in der klinischen Anwendung. Zukünftig ist zu erwarten, dass die OCTA durch longitudinale Studien mit größeren Fallzahlen Normwerte liefert, relevante Durchblutungsveränderungen bei verschiedensten Krankheitsbildern tiefgreifender analysiert und möglicherweise zu differenzialdiagnostischen und therapeutischen Zwecken beitragen wird.

Abstract

Within the last few years, optical coherence tomography angiography (OCTA) has been one of the most intensively investigated developments in ophthalmic research. As a non-invasive imaging tool, it can visualise retinal, choroidal and peripapillary blood flow and was first introduced in retinology. Recently, OCTA has received increasing attention in neuro-ophthalmological diagnostic testing. Special consideration has been given to diseases in which vascular pathogenesis is discussed, such as non-arteritic and arteritic anterior ischemic optic neuropathy (NAION and AAION). Numerous studies have demonstrated rarefication of the peripapillary vascular network and reduced blood flow in NAION and AAION patients compared to healthy patients. The extent of the vascular damage correlates with the severity of optic atrophy. Similar findings also apply to optic atrophy from other causes (e.g., optic nerve head drusen, hereditary optic neuropathy, etc.). However, the exact causal relationships between optic neuropathy and blood flow reduction remain unclear and must be addressed in future investigations. In some diseases, OCTA also seems to be of differential diagnostic value. In haemangioblastomas, it has provided relevant information, especially in large and broad-based findings, and may represent the haemangioblastoma-typical vascular networks and the afferent vessels. This review summarises new information from OCTA studies on neuro-ophthalmic diseases, and questions their relevance and value in clinical use. In the future, it can be expected that OCTA will provide standard values through longitudinal studies with larger numbers of cases that more relevant changes in blood flow in a wide variety of clinical pictures will be analysed more profoundly and will possibly contribute to differential diagnostic and therapeutic studies.

Schlüsselwörter

Neuroophthalmologie - optische Kohärenztomografie-Angiografie - OCTA - Flussdichte - Mikrozirkulation - Sehnerv

Key words

neuro-ophthalmology - optical coherence tomography angiography - OCTA - flow density - optic nerve head - microcirculation

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