Der Ophthalmologe

, Volume 105, Issue 12, pp 1108–1114 | Cite as

Risikofaktoren und Prävention der Retinopathia praematurorum

Leitthema
First Online:

Zusammenfassung

Die Geschichte der Retinopathia praematurorum (ROP) ist das Paradebeispiel dafür, wie gefährlich die unkontrollierte Einführung einer neuen Behandlungsform gerade in der Neonatologie sein kann. Wichtigste Risikofaktoren für eine ROP sind die Unreife der Frühgeborenen und die unkontrollierte bzw. inadäquate Behandlung mit Sauerstoff. Das Frühgeborene ist im Vergleich zum Feten einer unphysiologisch hohen Sauerstoffkonzentration ausgesetzt. Diese relative Hyperoxie führt einerseits zur Bildung aggressiver Sauerstoffradikale, andererseits zu einer reduzierten Produktion von Wachstumsfaktoren wie VEGF und EPO, die in der Pathogenese der ROP eine wichtige Rolle spielen. Wichtigste Maßnahme zur Prävention der ROP ist der sparsame und gut überwachte Einsatz von Sauerstoff. Medikamentöse Ansätze beinhalten die Injektion von D-Penicillamin und Vitamin A, wobei die Datenlage insbesondere hinsichtlich Langzeitwirkungen dieser Behandlungsformen noch sehr begrenzt ist. Eine gesteigerte Sauerstoffzufuhr bei bestehender Retinopathie führt nicht zur Besserung des Augenbefunds, erhöht aber die Häufigkeit pulmonaler Komplikationen. Eine Lichtreduktion auf Intensivstationen hat sich nicht als effizient zur Prävention der ROP erwiesen. Um behandlungsbedürftige Kinder rechtzeitig zu erfassen und die Erblindung zu vermeiden, ist ein standardisiertes konsequentes Screening der Risikogruppe erforderlich.

Schlüsselwörter

Retinopathia praematurorum Frühgeborene Sauerstoff Morbidität Prävention 

Risk factors and prevention of retinopathy of prematurity

Abstract

The history of retinopathy of prematurity (ROP) gives a prime example of how dangerous the uncontrolled introduction of a new medical treatment – particularly in the field of neonatology – may be. The most important risk factors for the development of ROP are the immaturity of premature infants as well as uncontrolled and/or inadequate treatment with oxygen. In comparison to the fetus, the premature infant is exposed to a nonphysiologically high oxygen concentration. This hyperoxia leads to formation of aggressive oxygen radicals on the one hand and, on the other hand, to temporarily reduced production of growth factors such as vascular endothelial growth factor and erythropoietin, which both play an important role in the pathogenesis of ROP. The most important measure to prevent ROP is restrictive and carefully monitored oxygen treatment. Medical treatment to prevent ROP includes injection of D-penicillamine and retinol, but the available data are still limited, particularly with regard to the long-term effects of this treatment. A higher oxygenation in prethreshold ROP does not lead to recovery of ocular findings, but it increases the incidence of pulmonary complications. A reduction of light intensity in neonatal intensive care units proved not to be efficient for preventing ROP. To avoid blindness, standardized screening of the risk group is needed.

Keywords

Retinopathy of prematurity Preterm infant Oxygen Morbidity Prevention 
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Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Zentrum für Kinder- und JugendmedizinPhilipps-Universität MarburgMarburgDeutschland

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