Bestehen Unterschiede bei Plaques der Arteria carotis interna und des Aortenbogens bei Patienten mit retinalen arteriellen Verschlüssen und anteriorer ischämischer Optikusneuropathie?

Zusammenfassung

Hintergrund: Retinale Arterienverschlüsse (RAO) und nichtarteritische anteriore ischämische Optikusneuropathie (NAION) verursachen schmerzlose Visusverschlechterungen und Gesichtsfeldausfälle. Assoziationen mit arteriosklerotischen Risikofaktoren, Hyperhomocysteinämie, Hyperfibrinogenämie und Plaques der Arteria (A.) carotis interna sind bekannt. In dieser Arbeit werden die Befunde der transösophagealen Echokardiografie und Sonografie der A. carotis interna erfasst und statistisch ausgewertet.
Material und Methode: 110 Patienten mit RAO und 49 Patienten mit NAION wurden retrospektiv erfasst und die Befunde mit SPSS 13.0 (IBM) mittels Mann-Whitney-Test (U-Test) statistisch ausgewertet.
Ergebnisse: RAO-Patienten haben statistisch signifikant öfter Plaques im Aortenbogen, mittelgroße Plaques in der A. carotis interna, eine Schlaganfallanamnese und Hyperhomocysteinämie. NAION-Patienten haben statistisch signifikant öfter kleine Plaques der A. carotis interna – alle anderen Parameter sind nicht statistisch signifikant unterschiedlich zwischen RAO und NAION.
Schlussfolgerung: RAO-Patienten sind im Median älter, haben öfter Plaques im Aortenbogen und größere Plaques in der A. carotis interna als NAION-Patienten. Beide Erkrankungen zeigen vergleichbare Assoziationen mit arteriosklerotischen Risikofaktoren.

Abstract

Introduction: Retinal artery occlusion (RAO) and non-arteritic anterior ischaemic optic neuropathy (NAION) cause painless vision deterioration and visual field defects. Associations with arteriosclerotic risk factors, hyperhomocysteinaemia, hyperfibrinogenaemia and plaques of the internal carotid artery are well kown. Results of transoesophageal echocardiography with respect to plaques in the aortic arch and duplex sonography of the internal carotid artery were evaluated and a statistical analysis was performed.
Material and Methods: 110 patients with RAO and 49 patients with NAION were retrospectively analysed. Statistical significant differences were analysed with the Mann-Whitney test (U test) using SPSS 13.0 (IBM).
Results: RAO patients have statistically significantly more often plaques in the aortic arch, medium-sized plaques of the internal carotid artery, a history of stroke and hyperhomocysteinaemia. NAION patients have statistically significantly more often small plaques of the internal carotid artery. All other parameters do not show statistically significant differences between both diseases.
Conclusions: RAO patients have a higher median age and seem to have more often arteriosclerotic plaques in the aortic arch and larger plaques in the internal carotid artery than NAION patients, although both diseases show comparable associations with arteriosclerotic risk factors.

Schlüsselwörter

Retina - Neuroophthalmologie - Glaskörper

Key words

retina - neuroophthalmology - vitreous

• Literatur

• 1 Hayreh SS, Zimmerman MB. Optic disc edema in non-arteritic anterior ischemic optic neuropathy. Graefes Arch Clin Exp Ophthalmol 2007; 245: 1107-1121
• 2 Hayreh SS, Joos KM, Podhajsky PA et al. Systemic diseases associated with nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol 1994; 118: 766-780
• 3 Hayreh SS, Podhajsky PA, Zimmerman MB. Retinal artery occlusion: associated systemic and ophthalmic abnormalities. Ophthalmology 2009; 116: 1928-1936
• 4 Schmidt D, Hetzel A, Geibel-Zehender A et al. Systemic diseases in non-inflammatory branch and central retinal artery occlusion – an overview of 416 patients. Eur J Med Res 2007; 12: 595-603
• 5 Schmidt D, Schumacher M, Feltgen N. Circadian incidence of non-inflammatory retinal artery occlusions. Graefes Arch Clin Exp Ophthalmol 2009; 247: 491-494
• 6 Leisser C. Hyperlipidaemia and increased systemic blood pressure – is there a connection to retinal artery occlusion?. Spektrum Augenheilkd 2010; 24: 154-156
• 7 Leisser C. Risk factors of retinal artery occlusion. Spektrum Augenheilkd 2012; 26: 202-204
• 8 Dunlap AB, Kosmorsky GS, Kashyap VS. The fate of patients with retinal artery occlusion and Hollenhorst plaque. J Vasc Surg 2007; 46: 1125-1129
• 9 Cugati S, Wang JJ, Rochtchina E et al. Ten-year incidence of retinal emboli in an older population. Stroke 2006; 37: 908-910
• 10 Wong TY, Larsen EK, Klein R et al. Cardiovascular risk factors for retinal vein occlusion and arteriolar emboli: the Atherosclerosis Risk in Communities & Cardiovascular Health studies. Ophthalmology 2005; 112: 540-547
• 11 Weger M, Stanger O, Deutschmann H et al. The role of hyperhomocysteinemia and methylenetetrahydrofolate reductase (MTHFR) C677T mutation in patients with retinal artery occlusion. Am J Ophthalmol 2002; 134: 57-61
• 12 Chua B, Kifley A, Wong TY et al. Homocysteine and retinal emboli: the Blue Mountains Eye Study. Am J Ophthalmol 2006; 142: 322-324
• 13 Cahill M, Karabatzaki M, Meleady R et al. Raised plasma homocysteine as a risk factor for retinal vacular occlusive disease. Br J Ophthalmol 2000; 84: 154-157
• 14 Pianka P, Almong Y, Man O et al. Hyperhomocystinemia in patients with nonarteritic anterior ischemic optic neuropathy, central retinal artery occlusion and central retinal vein occlusion. Ophthalmology 2000; 107: 1588-1592
• 15 Weger M, Stanger O, Deutschmann H et al. Hyperhomocyst(e)inaemia, but not MTHFR C677T mutation, as a risk factor for non-arteritic ischaemic optic neuropathy. Br J Ophthalmol 2001; 85: 803-806
• 16 Schmidt D, Richter T, van Reutern GM et al. Acute circulatory disorders of the eye. Clinical findings and results of Doppler sonography of the internal carotid artery. Fortschr Ophthalmol 1991; 88: 84-98
• 17 Tunick PA, Rosenzweig BP, Katz ES et al. High risk for vascular events in patients with protruding aortic atheromas: a prospective study. J Am Coll Cardiol 1994; 23: 1085-1090
• 18 Atherosclerotic disease of the aortic arch as a risk factor for recurrent ischemic stroke. The French Study of Aortic Plaques in Stroke Group. N Engl J Med 1996; 334: 1216-1221
• 19 Kramer M, Goldenberg-Cohen N, Shapira Y et al. Role of transesophageal echocardiography in the evaluation of patients with retinal artery occlusion. Ophthalmology 2001; 108: 1461-1464