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Kardiovaskuläre und hämostaseologische Sicht retinaler Gefäßverschlüsse

Cardiovascular and hemostaseological view of retinal vascular occlusions

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Zusammenfassung

Hintergrund

Plötzlich auftretende Sehminderungen sind oft durch akute Gefäßverschlüsse des hinteren Augenabschnitts bedingt und verlaufen schmerzlos. Bei den Gefäßverschlüssen der hinteren Augenabschnitte unterscheidet man arterielle von venösen Okklusionen. Dabei finden sich mit etwa 60 % aller Fälle häufiger venöse als arterielle Verschlüsse. Zusätzlich gibt es jedoch auch Mischbilder.

Ziel der Arbeit

Der Beitrag bietet eine Zusammenfassung der aktuellen Datenlage zur interdisziplinären Diagnostik und Therapie retinaler Gefäßverschlüsse.

Material und Methoden

Es erfolgte eine selektive Literaturrecherche unter Berücksichtigung klinisch relevanter kardiovaskulärer und hämostaseologischer Aspekte.

Ergebnisse

Die ophthalmologische Lokalisation des betroffenen Gefäßsegments kann dem Internisten entscheidende Hinweise für die weiterführende Diagnostik und Therapie geben. Bei arteriellen Verschlüssen muss an ein thromboembolisches Geschehen gedacht, Emboliequellen müssen identifiziert und diese internistisch behandelt werden. Venösen Verschlüssen liegen meist lokale Prozesse auf dem Hintergrund thrombophiler Hämostasestörungen oder blutdruckassoziierte venöse Stase zugrunde. Prognostisch sind die Lokalisation, das Ausmaß, die Dauer und die Intensität der retinalen Ischämie von besonderer Bedeutung.

Diskussion

Diese Erkrankungen des Auges sind meist eine Folge von internistischen Grunderkrankungen und stellen daher eine interdisziplinäre Herausforderung dar.

Abstract

Background

Sudden pain-free impairment of vision often occurs due to acute occlusions of retinal blood vessels. Retinal vascular occlusion can be distinguished into the more frequent venous and to a lesser degree arterial events but mixed pictures also occur.

Objectives

Summary of the current literature regarding interdisciplinary diagnosis and therapy of retinal blood vessel occlusions.

Materials and methods

Selective literature review considering clinically relevant cardiovascular and hemostaseological aspects.

Results

The anatomical localization of the occlusion by the ophthalmologist can give important indications for further medical diagnostic and therapeutic decisions. Arterial occlusions are mostly caused by thromboembolisms and the source should be identified and treated. Venous occlusions are mostly due to local processes with a prothrombotic background or venous stasis associated with arterial hypertension. Prognostically, the localization, extent and duration of retinal ischemia are decisive factors.

Conclusions

Vascular ocular occlusions are frequently secondary to internal disorders and therefore pose an interdisciplinary challenge.

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Abbreviations

ACE:

Angiotensin-Converting-Enzym

AAV:

Arterienastverschluss

APS:

Antiphospholipid-Syndrom

APC:

aktiviertes Protein C

ASS:

Acetylsalicylsäure

BSG:

Blutsenkungsgeschwindigkeit

CRP:

C-reaktives Protein

EMA:

Europäische Arzneimittel-Agentur

FVL:

Faktor-V-Leiden

HES:

Hydroxyethylstärke

Hkt:

Hämatokrit

LDL:

Low-Density-Lipoprotein

Lp(a):

Lipoprotein(a)

MTHFR:

Methylentetrahydrofolat-Reduktase

NAION:

nichtarteriitische anteriore ischämische Optikusneuropathie

NMH:

niedermolekulares Heparin

PAI:

Plasminogen-Aktivator-Inhibitor

RVV:

Retinaler Venenverschluss

t-PA:

Tissue-Plasminogen-Aktivator

VAV:

Venenastverschluss

ZAV:

Zentralarterienverschluss

ZVV:

Zentralvenenverschluss

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Einhaltung ethischer Richtlinien

Interessenkonflikt. H. Seidel, E. Stegemann und C. Heiss geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Correspondence to H. Seidel or C. Heiss.

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Seidel, H., Stegemann, E. & Heiss, C. Kardiovaskuläre und hämostaseologische Sicht retinaler Gefäßverschlüsse. Ophthalmologe 111, 23–30 (2014). https://doi.org/10.1007/s00347-013-2915-x

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  • DOI: https://doi.org/10.1007/s00347-013-2915-x

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