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Klin Monbl Augenheilkd 2010; 227(9): 712-720
DOI: 10.1055/s-0029-1245660
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Diagnostik und Therapie beim nicht arteriitischen Zentralarterienverschluss

Clinical Diagnostics and Therapy for Non-Arteritic Central Retinal Artery OcclusionA. Pielen1 , B. Junker1 , L. Hansen1 , H. Agostini1 , N. Feltgen2
  • 1Universitäts-Augenklinik, Freiburg
  • 2Augenklinik, Universitäts-Klinikum, Göttingen
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Publikationsverlauf

Eingegangen: 17.6.2010

Angenommen: 2.8.2010

Publikationsdatum:
15. September 2010 (online)

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Zusammenfassung

Der akute Zentralarterienverschluss (ZAV) ist eine ophthalmologische Notfallsituation. Die häufigsten Risikofaktoren sind eine arterielle Hypertonie, Herzrhythmusstörungen, Arteriosklerose, Hypercholesterinämie und Diabetes mellitus. Besonders bei älteren Patienten muss eine arteriitische Genese ausgeschlossen werden. Bei jungen Patienten (< 45 Jahre) ohne typische Risikofaktoren kann eine Thrombophilieabklärung sinnvoll sein. Für den nicht arteriitischen ZAV existiert keine einheitliche Therapieempfehlung. In der Literatur findet man zahlreiche Ansätze. Dazu zählen die Bulbusmassage, die systemische oder lokale Senkung des Augeninnendrucks, die Antikoagulation, die venöse systemische Lysetherapie und die kathetergeführte superselektive intraarterielle Lyse. In diesem Übersichtsartikel sollen sowohl die Ursachen des ZAV, die diagnostischen Maßnahmen zur Erkennung der Ursachen als auch die in der Literatur beschriebenen Therapieformen vorgestellt und kritisch bewertet werden. Ziel ist es, eine Orientierung über die notwendigen Schritte zur interdisziplinären Diagnostik in Kooperation mit Internisten und Neurologen und über die multimodale Therapie bei Patienten mit nicht arteriitischem ZAV zu geben.

Abstract

Central retinal artery occlusion (CRAO) is an ophthalmological emergency situation. Known risk factors are arterial hypertension, cardial arrhythmia, arteriosclerosis, hypercholesterolemia and diabetes. Elderly patients should be examined for an arteritic genesis. Young patients (< 45 years) without typical risk factors may suffer from thrombophilia. There is no uniform recommendation on how to treat non-arteritic CRAO. Many different interventions have been suggested in the literature, i. e., massaging the eye, systemic or local reduction of intraocular pressure, anticoagulation, either systemically administered venous thrombolysis or supraselective intra-arterial thrombolysis. In this review we present the causes of CRAO and diagnostic means to detect causes; we also critically discuss previously described therapeutic options. It is our aim to provide a guide through the necessary interdisciplinary diagnostics in co-operation with internal medicine and neurology and to recommend a multimodal therapy in patients with non-arteritic CRAO.

Schlüsselwörter

Retina - Pathologie - Zentralarterienverschluss - Diagnostik - Therapie

Key words

retina - pathology - central retinal artery occlusion - clinical diagnostics - therapy

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Dr. Amelie Pielen

Universitäts-Augenklinik

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79106 Freiburg

Telefon: ++ 49/7 61/2 70 40 01

Fax: ++ 49/7 61/2 70 40 63

eMail: amelie.pielen@uniklinik-freiburg.de