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Akute Retinanekrose

Acute retinal necrosis

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Zusammenfassung

Die akute Retinanekrose (ARN) ist eine seltene Retinitis internistisch gesunder Männer und Frauen. Viren der Herpesgruppe werden als infektiöses Agens angesehen. Die Erkrankung beginnt einseitig mit periorbitalen Schmerzen, Episkleritis oder Skleritis sowie einer anterioren, oft granulomatösen Uveitis. Diagnostisches Kernkriterium ist eine peripher beginnende nekrotisierende Retinitis mit deutlicher Glaskörperinfiltration, welche sich nach posterior ausbreitet. Typisch ist eine okklusive Vaskulitis, seltener eine Optikopathie. In 75% der Fälle entwickelt sich eine Netzhautablösung. Das Partnerauge ist in bis zu 2/3 der Fälle betroffen. Die Therapie umfasst in der Akutphase antivirale Infusionen, gefolgt von einer Erhaltungstherapie zur Vermeidung von Rezidiven und Befall des Partnerauges. Periphere Netzhautrisse können unter antiviraler Therapie gelasert werden. Die Vitrektomie mit Silikonöltamponade kann in über 90% eine Netzhautanlage bewirken, die Prognose quoad visum ist allerdings sehr begrenzt.

Abstract

Acute retinal necrosis syndrome (ARN) is a rare retinitis caused by the herpes virus family, including herpes simplex virus and varicella zoster virus. ARN most commonly occurs in otherwise healthy patients of either sex at any age. It is characterized by an initial onset of episcleritis or scleritis, periorbital pain, and a frequently granulomatous anterior uveitis. The key criterion is a necrotizing retinitis starting in the periphery and spreading towards the posterior pole, associated with vitreous opacification. Optic neuropathy may also occur. A total of 75% of untreated eyes develop retinal detachment within the first two months after onset of the disease. Two out of three ARN cases show involvement of the fellow eye. Early intravenous antiviral therapy is mandatory to stop ARN progression. Peripheral retinal breaks can be treated by laser photocoagulation, thereby reducing the risk of retinal detachment. Vitreoretinal surgery is often required, and silicon oil is the tamponade of choice in ARN, resulting in good reattachment rates (90%). Visual prognosis, however, is guarded.

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  1. Augenklinik, Ludwig-Maximilians-Universität München, Mathildenstraße 8, 80336, München, Deutschland

    A. Gandorfer & S. Thurau

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  1. A. Gandorfer
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  2. S. Thurau
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Correspondence to A. Gandorfer.

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Gandorfer, A., Thurau, S. Akute Retinanekrose. Ophthalmologe 106, 751–760 (2009). https://doi.org/10.1007/s00347-009-1986-1

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