Bildgebung bei Uveitis

Zusammenfassung

Bildgebende Verfahren sind Schlüsselelemente in der Diagnostik und Behandlung von Augenkrankheiten. Dies gilt insbesondere für intraokulare Entzündungen. In diesem Beitrag werden die aktuellen Bildgebungsmodalitäten wie optische Kohärenztomografie (OCT), OCT-Angiografie, Fluorescein- und Indocyaningrünangiografie, Fundusautofluoreszenz sowie Weitfeldbildgebungsmodalitäten erörtert. Der gezielte Einsatz dieser Untersuchungsmethoden wird abhängig vom Schwerpunkt der intraokularen Entzündung dargestellt. Zusätzlich werden aktuelle und künftige Möglichkeiten zum optimierten, objektiven Monitoring bei diesen Krankheitsbildern vorgestellt.

Abstract

Imaging is one of the key elements in the diagnosis and treatment of eye diseases. This is especially true for intraocular inflammation. In this article, the current imaging modalities such as optical coherence tomography (OCT), OCT angiography, fluorescein and indocyanine green angiography, fundus autofluorescence and wide-field imaging modalities are discussed. The use of these examination methods is illustrated, depending on the focus of intraocular inflammation. In addition, current and future options are presented for optimised, objective monitoring for these clinical entities.

Schlüsselwörter

Angiografie - Diagnostik - optische Kohärenztomografie - Monitoring - Uveitis

Key words

angiography - diagnostics - optical coherence tomography - monitoring - uveitis

• Literatur

• 1 Jabs DA, Nussenblatt RB, Rosenbaum JT. et al. Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop. Am J Ophthalmol 2005; 140: 509-516 doi:10.1016/j.ajo.2005.03.057
• 2 Dick AD, Rosenbaum JT, Al-Dhibi HA. et al. Guidance on noncorticosteroid systemic immunomodulatory therapy in noninfectious uveitis: fundamentals of care for uveitis (focus) initiative. Ophthalmology 2018; 125: 757-773 doi:10.1016/j.ophtha.2017.11.017
• 3 Deutsche Ophthalmologische Gesellschaft, Berufsverband der Augenärzte Deutschlands e. V.. Leitlinie Nr. 14: Uveitis anterior (Stand: 11.10.2010). Im Internet: https://www.dog.org/wp-content/uploads/2009/09/LL-Uveitis-anterior-2011-11-30-Endversion.pdf Stand: 05.02.2020
• 4 Agrawal R, Keane PA, Singh J. et al. Comparative analysis of anterior chamber flare grading between clinicians with different levels of experience and semi-automated laser flare photometry. Ocul Immunol Inflamm 2016; 24: 184-193 doi:10.3109/09273948.2014.990042
• 5 Sawa M, Tsurimaki Y, Tsuru T. et al. New quantitative method to determine protein concentration and cell number in aqueous in vivo. Jpn J Ophthalmol 1988; 32: 132-142
• 6 Ladas JG, Wheeler NC, Morhun PJ. et al. Laser flare-cell photometry: Methodology and clinical applications. Surv Ophthalmol 2005; 50: 27-47 doi:10.1016/j.survophthal.2004.10.004
• 7 Agrawal R, Keane PA, Singh J. et al. Classification of semi-automated flare readings using the Kowa FM 700 laser cell flare meter in patients with uveitis. Acta Ophthalmol 2016; 94: e135-e141 doi:10.1111/aos.12833
• 8 Gonzales CA, Ladas JG, Davis JL. et al. Relationships between laser flare photometry values and complications of uveitis. Arch Ophthalmol 2001; 119: 1763-1769 doi:10.1001/archopht.119.12.1763
• 9 Invernizzi A, Marchi S, Aldigeri R. et al. Objective quantification of anterior chamber inflammation: measuring cells and flare by anterior segment optical coherence tomography. Ophthalmology 2017; 124: 1670-1677 doi:10.1016/j.ophtha.2017.05.013
• 10 Lehpamer B, Moshier E, Goldberg N. et al. Subretinal fluid in uveitic macular edema: Effect on vision and response to therapy. Am J Ophthalmol 2013; 155: 143-149 doi:10.1016/j.ajo.2012.06.028
• 11 Lehpamer B, Moshier E, Pahk P. et al. Epiretinal membranes in uveitic macular edema: Effect on vision and response to therapy. Am J Ophthalmol 2014; 157: 1048-1055 doi:10.1016/j.ajo.2014.01.020
• 12 Grewal DS, OʼSullivan ML, Kron M. et al. Association of disorganization of retinal inner layers with visual acuity in eyes with uveitic cystoid macular edema. Am J Ophthalmol 2017; 177: 116-125 doi:10.1016/j.ajo.2017.02.017
• 13 Deutsche Ophthalmologische Gesellschaft, Berufsverband der Augenärzte Deutschlands e.V.. Leitlinie Nr. 24a: Uveitis intermedia (Stand: Juli 2014). Im Internet: https://www.dog.org/wp-content/uploads/2009/09/leit24a..pdf Stand: 05.02.2020
• 14 Nussenblatt RB, Palestine AG, Chan CC. et al. Standardization of vitreal inflammatory activity in intermediate and posterior uveitis. Ophthalmology 1985; 92: 467-471 doi:10.1016/s0161-6420(85)34001-0
• 15 Keane PA, Karampelas M, Sim DA. et al. Objective measurement of vitreous inflammation using optical coherence tomography. Ophthalmology 2014; 121: 1706-1714 doi:10.1016/j.ophtha.2014.03.006
• 16 Keane PA, Balaskas K, Sim DA. et al. Automated analysis of vitreous inflammation using spectral-domain optical coherence tomography. Transl Vis Sci Technol 2015; 4: 4 doi:10.1167/tvst.4.5.4
• 17 Laovirojjanakul W, Acharya N, Gonzales JA. Ultra-widefield fluorescein angiography in intermediate uveitis. Ocul Immunol Inflamm 2019; 27: 356-361 doi:10.1080/09273948.2017
• 18 Deutsche Ophthalmologische Gesellschaft, Berufsverband der Augenärzte Deutschlands e.V.. Leitlinie Nr. 24b: Nichtinfektiöse Uveitis posterior (Stand: August 2017). Im Internet: https://www.dog.org/wp-content/uploads/2009/09/LL-24b.pdf.pdf Stand: 09.02.2020
• 19 Kempen JH, Sugar EA, Jaffe GJ. et al. Fluorescein angiography versus optical coherence tomography for diagnosis of uveitic macular edema. Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group. Ophthalmology 2013; 120: 1852-1859 doi:10.1016/j.ophtha.2013.01.069
• 20 Pleyer U. Hrsg. Entzündliche Augenerkrankungen. Berlin, Heidelberg: Springer; 2014: 436-437
• 21 Kim BH, Shin JY, Yu HG. Discrepancy in fluorescein angiography and optical coherence tomography findings of macular edema in intermediate uveitis. Ocul Immunol Inflamm 2016; 24: 653-659 doi:10.3109/09273948.2015.1063668
• 22 Pohlmann D, Winterhalter S, Pleyer U. [White dot syndromes: principles, diagnostic and treatment]. Ophthalmologe 2019; 116: 1235-1256 doi:10.1007/s00347-019-01012-5
• 23 Pohlmann D, Pleyer U, Joussen AM. et al. Optical coherence tomography angiography in comparison to other multimodal imaging techniques in punctate inner choroidopathy. Br J Ophthalmol 2019; 103: 60-66 doi:10.1136/bjophthalmol-2017-311764
• 24 Markomichelakis NN, Halkiadakis I, Pantelia E. et al. Patterns of macular edema in patients with uveitis: qualitative and quantitative assessment using optical coherence tomography. Ophthalmology 2004; 111: 946-953 doi:10.1016/j.ophtha.2003.08.037
• 25 Invernizzi A, Agarwal AK, Ravera V. et al. Comparing optical coherence tomography findings in different aetiologies of infectious necrotising retinitis. Br J Ophthalmol 2018; 102: 433-437 doi:10.1136/bjophthalmol-2017-310210
• 26 Khairallah M, Abroug N, Khochtali S. et al. Optical coherence tomography angiography in patients with Behcet uveitis. Retina 2017; 37: 1678-1691 doi:10.1097/IAE.0000000000001418
• 27 Spaide RF. Microvascular flow abnormalities associated with retinal vasculitis: a potential of mechanism of retinal injury. Retina 2017; 37: 1034-1042 doi:10.1097/IAE.0000000000001359
• 28 Abucham-Neto JZ, Torricelli AAM, Lui ACF. et al. Comparison between optical coherence tomography angiography and fluorescein angiography findings in retinal vasculitis. Int J Retina Vitreous 2018; 4: 15 doi:10.1186/s40942-018-0117-z
• 29 Pohlmann D, Macedo S, Stübiger N. et al. Multimodal Imaging in Birdshot Retinochoroiditis. Ocul Immunol Inflamm 2017; 25: 621-632 doi:10.1080/09273948.2017.1375532
• 30 Astroz P, Miere A, Mrejen S. et al. Optical coherence tomography angiography to distinguish choroidal neovascularization from macular inflammatory lesions in multifocal choroiditis. Retina 2018; 38: 299-309 doi:10.1097/IAE.0000000000001617
• 31 Levison AL, Baynes KM, Lowder CY. et al. Choroidal neovascularisation on optical coherence tomography angiography in punctate inner choroidopathy and multifocal choroiditis. Br J Ophthalmol 2017; 101: 616-622 doi:10.1136/bjophthalmol-2016-308806
• 32 Lang GE, Enders C, Loid M. et al. Accurate OCT-angiography interpretation – detection and exclusion of artifacts. Klin Monatsbl Augenheilkd 2017; 234: 1109-1118 doi:10.1055/s-0043-112857