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Klin Monbl Augenheilkd 2025; 242(01): 71-86
DOI: 10.1055/a-2442-5175
CME-Fortbildung

Venöse Verschlüsse der Retina

Retinal Vein Occlusions
Nicolas Feltgen
,
Kristina Pfau
,
Josep Callizo
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Bei retinalen Venenverschlüssen handelt es sich um eine komplexe Systemerkrankung, bei der das zugrunde liegende Risikoprofil individuell eingegrenzt werden sollte. Augenärztlich muss immer ein Glaukom oder eine okuläre Hypertension ausgeschlossen sowie nach vaskulären Systemerkrankungen oder Risikofaktoren gesucht werden. In der Behandlung kommen intravitreal applizierte Medikamente, Laserkoagulation oder eine Kombination in Frage.

Abstract

As retinal vein occlusion is such a complex systemic disease, its underlying risk profile should be narrowed down individually. Ophthalmologists should always rule out glaucoma or ocular hypertension while also screening the patient for systemic vascular diseases or risk factors in particular. Intravitreally applied medication (VEGF inhibitors or steroids) and laser coagulation (focal or panretinal) or a combination thereof can be considered to treat such retinal anomalies.

Kernaussagen

  • Der retinale Venenverschluss ist eine komplexe Systemerkrankung, die nicht auf das Auge beschränkt ist.

  • Sowohl die internistische Abklärung als auch die ophthalmologische Therapie stellen 2 gleichwertige Säulen einer adäquaten und modernen Behandlung dar. Für die diagnostische Abklärung braucht es eine intensive Zusammenarbeit mit den Fachkollegen.

  • Bei der ophthalmologischen Behandlung muss die Frage nach einem Glaukom oder einer okulären Hypertension beantwortet werden.

  • Weiterhin muss das Alter des Verschlusses und die Frage nach einem Makulaödem geklärt werden, weil dies direkte Auswirkungen auf die Behandlungsempfehlung hat.

  • Die Kontrollen sollen auch ohne Therapie zumindest 1× im Quartal erfolgen, dabei soll immer auf proliferative Zeichen geachtet werden.

  • Bei einem Makulaödem ist eine Injektionsbehandlung indiziert, diese wird vornehmlich mit VEGF-Inhibitoren durchgeführt.

  • Bei älteren Verschlüssen oder fehlendem Ansprechen kann auch Dexamethason eingesetzt werden.

  • Bei einer retinalen Ischämie ist i. d. R. eine gezielte Laserkoagulation erforderlich.

  • Die wiederholte Beurteilung des Ischämiegrades anhand klinischer Zeichen (Visus, RAPD, Cotton-Wool-Herde) gehört zu jeder Kontrolluntersuchung.

  • Aufgrund der komplexen Erkrankung ist es wichtig, die Betroffenen gleich beim ersten Kontakt darauf hinzuweisen, dass wiederholte und längerfristige Kontrollen erforderlich sind.

Schlüsselwörter

Glaukom - Sehverschlechterung - Laserkoagulation - vaskuläre Erkrankung - IVOM

Keywords

Glaucoma - visual impairment - Lasercoagulation - vascular disease - IVOM


Publication History

Article published online:
06 December 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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