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Antiphospholipidsyndrom und retinale venöse Verschlüsse

Metaanalyse publizierter Studien

Antiphospholipid syndrome and retinal vein occlusion

Meta-analysis of Published Studies

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Zusammenfassung

Der Anteil des Antiphospholipidsyndroms (APS) an der Pathogenese von retinalen venösen Verschlüssen wird seit Jahren diskutiert. Einzelne Studien hierzu erbrachten oft widersprüchliche Ergebnisse, weil die meisten Studien kein kontrolliertes Design hatten und die Fallzahlen klein waren. In der vorliegenden Arbeit führten wir eine Metaanalyse durch, die alle bis jetzt publizierten Studien einschließt, welche den diagnostischen Kriterien für APS entsprechen. Hierzu wurde eine Literaturrecherche bis einschließlich Juli 2007 durchgeführt. Die Ergebnisse der Metaanalyse zeigen, dass die Prävalenz des APS bei Patienten mit retinalen venösen Verschlüssen im Vergleich zur Kontrollgruppe signifikant höher ist. Die Patienten mit einem APS werden wegen des deutlich erhöhten Risikos eines Thromboserezidivs antikoaguliert. Daher scheint nach jetzigem Wissen ein APS-Screening für alle Patienten mit retinalen venösen Verschlüssen und im Falle einer APS-Positivität die Durchführung einer Antikoagulation sinnvoll zu sein. Für Patienten mit einem retinalen venösen Verschluss in Rahmen eines APS liegen zurzeit bezüglich der Rezidivrate einer Thrombose keine Daten vor. Deswegen muss eine prospektive randomisierte Studie durchgeführt werden, die den Nutzen der antikoagulativen Therapie bei diesen Patienten untersucht. Erst danach kann eine endgültige Empfehlung für die klinische Behandlung gegeben werden.

Abstract

The role of antiphospholipid syndrome (APS) in the pathogenesis of retinal vein occlusion has been discussed for several years. Conflicting results of the published studies are caused by small numbers of investigated patients and lack of control groups. We performed a meta-analysis of all case-control studies published up to July 2007 that investigated the prevalence of APS according to current diagnostic criteria for this syndrome.

The results of meta-analysis show a significantly higher prevalence of APS in patients with retinal vein occlusion compared with controls. Patients with APS are treated with anticoagulants to reduce the risk of recurrence of thrombosis. Therefore, screening for APS seems to be indicated in all patients with retinal vein occlusion, and, in the case of a positive result, initiation of anticoagulation. For patients with retinal vein occlusion with APS, no data are currently available regarding the recurrence of thrombosis. To give a clear recommendation, a prospective randomized study is required to investigate the benefit of anticoagulation.

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Authors and Affiliations

  1. Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Liebigstraße 10–14, 04103, Leipzig, Deutschland

    M. Rehak, J. Wiercinska & P. Wiedemann

  2. Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare Diagnostik, Universitätsklinikum Leipzig, Leipzig, Deutschland

    M. Müller

  3. Institut für medizinische Informatik, Statistik und Epidemiologie (IMISE), Universität Leipzig, Leipzig, Deutschland

    M. Scholz

  4. Medizinische Klinik und Poliklinik II - Hämatologie und Onkologie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    D. Niederwieser

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  1. M. Rehak
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  2. M. Müller
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  3. M. Scholz
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  4. J. Wiercinska
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  5. D. Niederwieser
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  6. P. Wiedemann
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Correspondence to M. Rehak.

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Der Vortrag wurde auf der 105. Tagung der Deutschen Ophthalmologischen Gesellschaft gehalten.

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Rehak, M., Müller, M., Scholz, M. et al. Antiphospholipidsyndrom und retinale venöse Verschlüsse. Ophthalmologe 106, 427–434 (2009). https://doi.org/10.1007/s00347-008-1811-2

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  • DOI: https://doi.org/10.1007/s00347-008-1811-2

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