RSS-Feed abonnieren
DOI: 10.1055/s-0029-1245660
© Georg Thieme Verlag KG Stuttgart · New York
Diagnostik und Therapie beim nicht arteriitischen Zentralarterienverschluss
Clinical Diagnostics and Therapy for Non-Arteritic Central Retinal Artery OcclusionPublikationsverlauf
Eingegangen: 17.6.2010
Angenommen: 2.8.2010
Publikationsdatum:
15. September 2010 (online)

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
Literatur
- 1
Hayreh S S, Kolder H E, Weingeist T A.
Central retinal artery occlusion and retinal tolerance time.
Ophthalmology.
1980;
87
75-78
MissingFormLabel
- 2
Rumelt S, Dorenboim Y, Rehany U.
Aggressive systematic treatment for central retinal artery occlusion.
Am J Ophthalmol.
1999;
128
733-738
MissingFormLabel
- 3
Feltgen N, Schmidt D, Hansen L.
Occlusion of the retinal artery.
Ophthalmologe.
2003;
100
651-665, quiz 666 – 657
MissingFormLabel
- 4
Hayreh S S, Zimmerman M B.
Fundus changes in central retinal artery occlusion.
Retina.
2007;
27
276-289
MissingFormLabel
- 5
Hayreh S S, Zimmerman M B.
Central retinal artery occlusion: visual outcome.
Am J Ophthalmol.
2005;
140
376-391
MissingFormLabel
- 6
Lange C, Feltgen N, Junker B et al.
Resolving the clinical acuity categories ”hand motion” and ”counting fingers” using
the Freiburg Visual Acuity Test (FrACT).
Graefes Arch Clin Exp Ophthalmol.
2009;
247
137-142
MissingFormLabel
- 7
Augsburger J J, Magargal L E.
Visual prognosis following treatment of acute central retinal artery obstruction.
Br J Ophthalmol.
1980;
64
913-917
MissingFormLabel
- 8
Schmidt D, Schumacher M, Wakhloo A K.
Microcatheter urokinase infusion in central retinal artery occlusion.
Am J Ophthalmol.
1992;
113
429-434
MissingFormLabel
- 9
Arnold M, Koerner U, Remonda L et al.
Comparison of intra-arterial thrombolysis with conventional treatment in patients
with acute central retinal artery occlusion.
J Neurol Neurosurg Psychiatry.
2005;
76
196-199
MissingFormLabel
- 10
Atebara N H, Brown G C, Cater J.
Efficacy of anterior chamber paracentesis and Carbogen in treating acute nonarteritic
central retinal artery occlusion.
Ophthalmology.
1995;
102
2029-2034, discussion 2034 – 2025
MissingFormLabel
- 11
Brown G C, Magargal L E.
Central retinal artery obstruction and visual acuity.
Ophthalmology.
1982;
89
14-19
MissingFormLabel
- 12
Karjalainen K.
Occlusion of the central retinal artery and retinal branch arterioles. A clinical,
tonographic and fluorescein angiographic study of 175 patients.
Acta Ophthalmol.
1971;
109
1-95
MissingFormLabel
- 13
Mueller A J, Neubauer A S, Schaller U et al.
Evaluation of Stunden imally invasive therapies and rationale for a prospective randomized
trial to evaluate selective intra-arterial lysis for clinically complete central retinal
artery occlusion.
Arch Ophthalmol.
2003;
121
1377-1381
MissingFormLabel
- 14
Sharma S.
The systemic evaluation of acute retinal artery occlusion.
Curr Opin Ophthalmol.
1998;
9
1-5
MissingFormLabel
- 15
Neubauer A S, Mueller A J, Schriever S et al.
Minimally invasive therapy for clinically complete central retinal artery occlusion
– results and meta-analysis of literature.
Klin Monbl Augenheilkd.
2000;
217
30-36
MissingFormLabel
- 16
Sanborn G ML.
Arterial obstructive disease of the eye.
Duane’s clinical ophthalmology.
1990;
3
1-29
MissingFormLabel
- 17 Sharma S, Brown C. Retinal arterial obstructive disease. St. Louis: Mosby; 1994: 1361-1377
MissingFormLabel
- 18
Schmidt D, Schumacher M, Feltgen N.
Circadian incidence of non-inflammatory retinal artery occlusions.
Graefes Arch Clin Exp Ophthalmol.
2009;
247
491-494
MissingFormLabel
- 19
David N J, Norton E W, Gass J D et al.
Fluorescein angiography in central retinal artery occlusion.
Arch Ophthalmol.
1967;
77
619-629
MissingFormLabel
- 20
Gold D.
Retinal arterial occlusion.
Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol.
1977;
83
OP392-OP408
MissingFormLabel
- 21
Wolf S, Hoberg A, Bertram B et al.
Video fluorescein angiography follow-up of patients with retinal artery occlusion.
Klin Monbl Augenheilkd.
1989;
195
154-160
MissingFormLabel
- 22
Ghazi N G, Tilton E P, Patel B et al.
Comparison of macular optical coherence tomography findings between postacute retinal
artery occlusion and nonacute optic neuropathy.
Retina.
2010;
30
578-585
MissingFormLabel
- 23
Duker J S, Brown G C.
Iris neovascularization associated with obstruction of the central retinal artery.
Ophthalmology.
1988;
95
1244-1250
MissingFormLabel
- 24
Duker J S, Sivalingam A, Brown G C et al.
A prospective study of acute central retinal artery obstruction. The incidence of
secondary ocular neovascularization.
Arch Ophthalmol.
1991;
109
339-342
MissingFormLabel
- 25
Rudkin A K, Lee A W, Chen C S.
Vascular risk factors for central retinal artery occlusion.
Eye.
2010;
24
678-681
MissingFormLabel
- 26 Pantenburg S, Pielen A, Junker B et al. Risk evaluation in patients with acute non-arteriitic central retinal artery occlusion. World Ophthalmology Congress. Berlin; 2010
MissingFormLabel
- 27
Klatt C, Purtskhvanidze K, Hasselbach H et al.
Retrospective case analysis of ophthalmological and systemic risk factors in patients
with retinal vascular occlusion.
Ophthalmologe.
2010;
107
446-451
MissingFormLabel
- 28
Wang J J, Cugati S, Knudtson M D et al.
Retinal arteriolar emboli and long-term mortality: pooled data analysis from two older
populations.
Stroke.
2006;
37
1833-1836
MissingFormLabel
- 29
Mirshahi A, Feltgen N, Hansen L L et al.
Retinal vascular occlusions: an interdisciplinary challenge.
Dtsch Arztebl Int.
2008;
105
474-479
MissingFormLabel
- 30
Heinz J.
Internistische Untersuchungen beim nicht-arteriitischen retinalen Arterienverschluss.
Ophthalmologe.
2010;
[im Druck]
MissingFormLabel
- 31
Hayreh S S, Podhajsky P A, Zimmerman M B.
Retinal artery occlusion: associated systemic and ophthalmic abnormalities.
Ophthalmology.
2009;
116
1928-1936
MissingFormLabel
- 32
Nagy V, Takacs L, Steiber Z et al.
Thrombophilic screening in retinal artery occlusion patients.
Clin Ophthalmol.
2008;
2
557-561
MissingFormLabel
- 33
Glueck C J, Wang P.
Ocular vascular thrombotic events: a diagnostic window to familial thrombophilia (compound
factor V Leiden and prothrombin gene heterozygosity) and thrombosis.
Clin Appl Thromb Hemost.
2009;
15
12-18
MissingFormLabel
- 34
Larsson J.
Central retinal artery occlusion in a patient homozygous for factor V Leiden.
Am J Ophthalmol.
2000;
129
816-817
MissingFormLabel
- 35
Willeke A, Gerdsen F, Bauersachs R M et al.
Rationelle Thrombophiliediagnostik.
Deutsches Ärzteblatt.
2002;
99
2111-2118
MissingFormLabel
- 36
Cahill M T, Stinnett S S, Fekrat S.
Meta-analysis of plasma homocysteine, serum folate, serum vitamin B(12), and thermolabile
MTHFR genotype as risk factors for retinal vascular occlusive disease.
Am J Ophthalmol.
2003;
136
1136-1150
MissingFormLabel
- 37
Miserocchi E, Baltatzis S, Foster C S.
Ocular features associated with anticardiolipin antibodies: a descriptive study.
Am J Ophthalmol.
2001;
131
451-456
MissingFormLabel
- 38
Cobo-Soriano R, Sanchez-Ramon S, Aparicio M J et al.
Antiphospholipid antibodies and retinal thrombosis in patients without risk factors:
a prospective case-control study.
Am J Ophthalmol.
1999;
128
725-732
MissingFormLabel
- 39
Moerloose de P, Boehlen F.
Inherited thrombophilia in arterial disease: a selective review.
Semin Hematol.
2007;
44
106-113
MissingFormLabel
- 40
Toole J F, Malinow M R, Chambless L E et al.
Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke,
myocardial infarction, and death: the Vitamin Intervention for Stroke Prevention (VISP)
randomized controlled trial.
Jama.
2004;
291
565-575
MissingFormLabel
- 41
Harino S, Grunwald J E, Petrig B J et al.
Rebreathing into a bag increases human retinal macular blood velocity.
Br J Ophthalmol.
1995;
79
380-383
MissingFormLabel
- 42
Frayser R, Hickam J B.
Retinal Vascular Response to Breathing Increased Carbon Dioxide and Oxygen Concentrations.
Invest Ophthalmol.
1964;
3
427-431
MissingFormLabel
- 43
Deutsch T A, Read J S, Ernest J T et al.
Effects of oxygen and carbon dioxide on the retinal vasculature in humans.
Arch Ophthalmol.
1983;
101
1278-1280
MissingFormLabel
- 44
Schmetterer L, Lexer F, Findl O et al.
The effect of inhalation of different mixtures of O2 and CO2 on ocular fundus pulsations.
Exp Eye Res.
1996;
63
351-355
MissingFormLabel
- 45
Aisenbrey S, Krott R, Heller R et al.
Hyperbaric oxygen therapy in retinal artery occlusion.
Ophthalmologe.
2000;
97
461-467
MissingFormLabel
- 46
Weinberger A W, Siekmann U P, Wolf S et al.
Treatment of Acute Central Retinal Artery Occlusion (CRAO) by Hyperbaric Oxygenation
Therapy (HBO) – Pilot study with 21 patients.
Klin Monbl Augenheilkd.
2002;
219
728-734
MissingFormLabel
- 47
Ffytche T J.
A rationalization of treatment of central retinal artery occlusion.
Trans Ophthalmol Soc U K.
1974;
94
468-479
MissingFormLabel
- 48
Chen J C, Cheema D.
Repeated anterior chamber paracentesis for the treatment of central retinal artery
occlusion.
Can J Ophthalmol.
1994;
29
207-209
MissingFormLabel
- 49
Harvey P A, Winder S, Talbot J F.
Trabeculectomy for central retinal artery occlusion.
Eye (Lond).
2000;
14 (Pt 2)
256-257
MissingFormLabel
- 50
Rassam S M, Patel V, Kohner E M.
The effect of acetazolamide on the retinal circulation.
Eye (Lond).
1993;
7 (Pt 5)
697-702
MissingFormLabel
- 51
Opremcak E M, Benner J D.
Translumenal Nd:YAG laser embolysis for branch retinal artery occlusion.
Retina.
2002;
22
213-216
MissingFormLabel
- 52
Opremcak E, Rehmar A J, Ridenour C D et al.
Restoration of retinal blood flow via translumenal Nd:YAG embolysis/embolectomy (TYL/E)
for central and branch retinal artery occlusion.
Retina.
2008;
28
226-235
MissingFormLabel
- 53
Reynard M, Hanscom T A.
Neodymium:yttrium-aluminum-garnet laser arteriotomy with embolectomy for central retinal
artery occlusion.
Am J Ophthalmol.
2004;
137
196-198
MissingFormLabel
- 54
Haritoglou C, Wolf A, Ulbig M W.
Laser embolectomy for central retinal artery occlusion.
Ophthalmologe.
2010;
107
465-467
MissingFormLabel
- 55
Dutton G N, Craig G.
Treatment of retinal embolus by photocoagulation.
Br J Ophthalmol.
1989;
73
580-581
MissingFormLabel
- 56
Ciulla T A, D’Amico D J, Miller J W.
Laser photodisruption of visible retinal artery emboli.
Br J Ophthalmol.
1995;
79
964-965
MissingFormLabel
- 57
Garcia-Arumi J, Martinez-Castillo V, Boixadera A et al.
Surgical embolus removal in retinal artery occlusion.
Br J Ophthalmol.
2006;
90
1252-1255
MissingFormLabel
- 58
Tang W M, Topping T M.
Vitreous surgery for central retinal artery occlusion.
Arch Ophthalmol.
2000;
118
1586-1587
MissingFormLabel
- 59
Tang W M, Han D P.
A study of surgical approaches to retinal vascular occlusions.
Arch Ophthalmol.
2000;
118
138-143
MissingFormLabel
- 60
Hayreh S S.
Restoration of retinal blood flow via translumenal Nd:YAG embolysis/embolectomy (TYL/E)
for central and branch retinal artery occlusion.
Retina.
2008;
28
1369-1372, author reply 1372 – 1363
MissingFormLabel
- 61
Beatty S, Au Eong K G.
Local intra-arterial fibrinolysis for acute occlusion of the central retinal artery:
a meta-analysis of the published data.
Br J Ophthalmol.
2000;
84
914-916
MissingFormLabel
- 62
Hattenbach L O, Kuhli-Hattenbach C, Scharrer I et al.
Intravenous thrombolysis with low-dose recombinant tissue plasminogen activator in
central retinal artery occlusion.
Am J Ophthalmol.
2008;
146
700-706
MissingFormLabel
- 63
Kattah J C, Wang D Z, Reddy C.
Intravenous recombinant tissue-type plasminogen activator thrombolysis in treatment
of central retinal artery occlusion.
Arch Ophthalmol.
2002;
120
1234-1236
MissingFormLabel
- 64
Margo C E, Mack W P.
Therapeutic decisions involving disparate clinical outcomes: patient preference survey
for treatment of central retinal artery occlusion.
Ophthalmology.
1996;
103
691-696
MissingFormLabel
- 65
Annonier P, Sahel J, Wenger J J et al.
Local fibrinolytic treatment in occlusions of the central retinal artery.
J Fr Ophtalmol.
1984;
7
711-716
MissingFormLabel
- 66
Zeumer H, Freitag H J, Grzyska U et al.
Local intraarterial fibrinolysis in acute vertebrobasilar occlusion. Technical developments
and recent results.
Neuroradiology.
1989;
31
336-340
MissingFormLabel
- 67
Butz B, Strotzer M, Manke C et al.
Selective intraarterial fibrinolysis of acute central retinal artery occlusion.
Acta Radiol.
2003;
44
680-684
MissingFormLabel
- 68
Richard G, Lerche R C, Knospe V et al.
Treatment of retinal arterial occlusion with local fibrinolysis using recombinant
tissue plasminogen activator.
Ophthalmology.
1999;
106
768-773
MissingFormLabel
- 69
Pettersen J A, Hill M D, Demchuk A M et al.
Intra-arterial thrombolysis for retinal artery occlusion: the Calgary experience.
Can J Neurol Sci.
2005;
32
507-511
MissingFormLabel
- 70
Schumacher M, Schmidt D, Wakhloo A K.
Intra-arterial fibrinolytic therapy in central retinal artery occlusion.
Neuroradiology.
1993;
35
600-605
MissingFormLabel
- 71
Barth H, Stein H, Fasse A et al.
Intracerebral hemorrhage after systemic thrombolysis in patients with occlusion of
the central retinal artery. Report of 2 cases.
Ophthalmologe.
1996;
93
739-744
MissingFormLabel
- 72
Bertram B, Wolf S, Fisches H et al.
Thrombolytic treatment of retinal arterial occlusions with plasminogen activator.
Klin Monbl Augenheilkd.
1991;
198
295-300
MissingFormLabel
- 73
Tsai F Y, Wadley D, Angle J F et al.
Superselective ophthalmic angiography for diagnostic and therapeutic use.
Am J Neuroradiol.
1990;
11
1203-1204
MissingFormLabel
- 74
Biousse V, Calvetti O, Bruce B B et al.
Thrombolysis for central retinal artery occlusion.
J Neuroophthalmol.
2007;
27
215-230
MissingFormLabel
- 75
Aldrich E M, Lee A W, Chen C S et al.
Local intraarterial fibrinolysis administered in aliquots for the treatment of central
retinal artery occlusion: the Johns Hopkins Hospital experience.
Stroke.
2008;
39
1746-1750
MissingFormLabel
- 76
Schmidt D P, Schulte-Monting J, Schumacher M.
Prognosis of central retinal artery occlusion: local intraarterial fibrinolysis versus
conservative treatment.
Am J Neuroradiol.
2002;
23
1301-1307
MissingFormLabel
- 77
Padolecchia R, Puglioli M, Ragone M C et al.
Superselective intraarterial fibrinolysis in central retinal artery occlusion.
Am J Neuroradiol.
1999;
20
565-567
MissingFormLabel
- 78
Feltgen N, Neubauer A, Jurklies B et al.
Multicenter study of the European Assessment Group for Lysis in the Eye (EAGLE) for
the treatment of central retinal artery occlusion: design issues and implications.
EAGLE Study report no. 1: EAGLE Study report no. 1.
Graefes Arch Clin Exp Ophthalmol.
2006;
244
950-956
MissingFormLabel
- 79
Schumacher M, Schmidt D, Jurklies B et al.
Central retinal artery occlusion: local intra-arterial fibrinolysis versus conservative
treatment, a multicenter randomized trial.
Ophthalmology.
2010;
117
1367-1375
MissingFormLabel
- 80
Sandercock P, Gubitz G, Foley P et al.
Antiplatelet therapy for acute ischaemic stroke.
Cochrane Database Syst Rev.
2003;
CD000029
MissingFormLabel
- 81
Holschermann H, Krombach C, Jung A et al.
Treatment of acute central retinal artery occlusionwith the platelet glycoprotein
IIb/IIIa receptor inhibitor tirofiban.
Thromb Haemost.
2005;
94
684-686
MissingFormLabel
- 82
Rufer F, Schroder A, Winter R et al.
Analysis of risk factors and comparison of heparin and hemodilution therapies for
retinal artery occlusion.
Ophthalmologe.
2003;
100
819-824
MissingFormLabel
- 83
Iwafune Y, Yoshimoto H.
Clinical use of pentoxifylline in haemorrhagic disorders of the retina.
Pharmatherapeutica.
1980;
2
429-438
MissingFormLabel
- 84
Kieswetter H, Korber N, Jung F et al.
Rheologic findings in patients with acute central retinal artery occlusion.
Graefes Arch Clin Exp Ophthalmol.
1983;
220
92-95
MissingFormLabel
- 85
Incandela L, Cesarone M R, Belcaro G et al.
Treatment of vascular retinal disease with pentoxifylline: a controlled, randomized
trial.
Angiology.
2002;
53 (Suppl 1)
S31-S34
MissingFormLabel
- 86
Fraser S G, Adams W.
Interventions for acute non-arteritic central retinal artery occlusion.
Cochrane Database Syst Rev.
2009;
CD001989
MissingFormLabel
- 87
Hausmann N, Richard G.
Effect of high dose steroid bolus on occlusion of ocular central artery: angiographic
study.
Bmj.
1991;
303
1445-1446
MissingFormLabel
- 88
Pettersson T, Bondesson S, Cojocaru D et al.
One year follow-up of patients with refractory angina pectoris treated with enhanced
external counterpulsation.
BMC Cardiovasc Disord.
2006;
6
28
MissingFormLabel
- 89
Werner D, Michalk F, Harazny J et al.
Accelerated reperfusion of poorly perfused retinal areas in central retinal artery
occlusion and branch retinal artery occlusion after a short treatment with enhanced
external counterpulsation.
Retina.
2004;
24
541-547
MissingFormLabel
- 90
Jehle T, Wingert K, Dimitriu C et al.
Quantification of ischemic damage in the rat retina: a comparative study using evoked
potentials, electroretinography, and histology.
Invest Ophthalmol Vis Sci.
2008;
49
1056-1064
MissingFormLabel
- 91
Hayreh S S, Weingeist T A.
Experimental occlusion of the central artery of the retina. IV: Retinal tolerance
time to acute ischaemia.
Br J Ophthalmol.
1980;
64
818-825
MissingFormLabel
- 92
Hayreh S S, Weingeist T A.
Experimental occlusion of the central artery of the retina. I. Ophthalmoscopic and
fluorescein fundus angiographic studies.
Br J Ophthalmol.
1980;
64
896-912
MissingFormLabel
- 93
Duker J S, Brown G C.
Recovery following acute obstruction of the retinal and choroidal circulations. A
case history.
Retina.
1988;
8
257-260
MissingFormLabel
- 94 Ehrhardt B A, Kürzinger G RK, Lang G E. Hemodilution therapy in central retinal artery occlusion. WOC. Berlin; 2010
MissingFormLabel
- 95
Hayreh S S.
Retinal arterial occlusion with LIF using rTPA.
Ophthalmology.
1999;
106
1236-1239
MissingFormLabel
- 96
Lorentzen S E.
Occlusion of the central retinal artery. A follow-up.
Acta Ophthalmol (Copenh).
1969;
47
690-703
MissingFormLabel
Dr. Amelie Pielen
Universitäts-Augenklinik
Killianstraße 5
79106 Freiburg
Telefon: ++ 49/7 61/2 70 40 01
Fax: ++ 49/7 61/2 70 40 63
eMail: amelie.pielen@uniklinik-freiburg.de