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Makulaschichtforamen mit hyporeflektivem epiretinalem Gewebe

OCT-Diagnostik und klinischer Verlauf

Lamellar macular holes with hyporeflective epiretinal proliferation

OCT diagnostics and clinical course

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Zusammenfassung

Hintergrund

Die hochauflösende Spektral-Domain-optische Kohärenztomographie (SD-OCT) ist die Standarduntersuchung zur Beurteilung nicht vollständig durchgreifender Makuladefekte. Anhand in der SD-OCT festgelegter Diagnosekriterien ist das Makulaschichtforamen (MSF) vom Pseudoforamen (PF) abzugrenzen und zeichnet sich durch eine irreguläre foveale Kontur, einen Defekt der inneren Fovea sowie eine innere Spaltbildung aus.

Fragestellung

Ziel der Arbeit ist ein Überblick über den aktuellen Kenntnisstand zur Diagnostik und zum klinischen Verlauf von MSF.

Material und Methoden

Die Auswertung basiert auf dem aktuellen Stand der Literatur und eigenen Datenauswertungen aus der Augenklinik der Universität München.

Ergebnisse

Bei der Mehrzahl der Augen mit MSF lassen sich neben konventionellen traktiven epiretinalen Membranen (ERM) homogene atypische epiretinale Proliferationen (LHEP) beschreiben. Diese zeigen sich in der SD-OCT als hyporeflektives dicht aufgelagertes Material und weisen im Gegensatz zur klassischen ERM keine kontraktilen Zellkomponenten auf. Das Vorkommen von LHEP korreliert im SD-OCT mit Defekten der Photorezeptorschicht, dünnerer fovealer Netzhautdicke und einer Zunahme der intraretinalen Spaltbildung mit Gewebeverlust sowie mit einer schlechteren Sehschärfe. Die Fundusautofluoreszenz (FAF) war bei allen Augen mit MSF positiv.

Schlussfolgerung

Die Korrelation von SD-OCT und En-face-OCT kann helfen, Subgruppen zu identifizieren und eine Progression frühzeitig zu erkennen. Die FAF erlaubt eine erste Detektion struktureller Veränderungen bereits im subklinischen Stadium ohne Visuseinschränkung. Die derzeit gültige Klassifikation sollte aufgrund von Übergangformen zu PF der Makula und hoher Variabilität der intraretinalen Spaltbildung sowie der epiretinalen Proliferation überdacht werden.

Abstract

Background

High-resolution spectral domain optical coherence tomography (SD-OCT) is the standard examination for assessment of lamellar macular holes (LMH). According to the current SD-OCT classification of LMHs, they are characterized by (1) an irregular foveal contour, (2) a defect in the inner fovea, and (3) a separation of inner retinal layers from outer retinal layers of the fovea leading to an intraretinal splitting with loss of retinal tissue.

Objective

The article aims to give an overview on the current knowledge of retinal imaging in LMH diagnostics and clinical course of disease.

Materials and methods

This review is based on current literature and analyses of data from different case series from the Department of Ophthalmology, Ludwig-Maximilian University Munich, Germany.

Results

In eyes with LMH, a homogenous atypical, hyporeflective epiretinal tissue has been described in addition to conventional tractional epiretinal membranes (ERM). By SD-OCT, this named lamellar hole-associated epiretinal proliferation (LHEP) does not show common signs of traction and is characterized as a thick homogenous layer of moderately reflective material. LHEP has been demonstrated to be related to the occurrence of photoreceptor layer defects, enlargement of LMH diameter and poor visual acuity.

Conclusion

The correlation of SD-OCT and en-face OCT can help to identify LMH subgroups and morphology progression early on. FAF enables detection of structural changes at a subclinical stage without visual deterioration. With regard to a high variability of intraretinal changes in LMHs and epimacular fibro-cellular proliferation, the current classification of LMH should be discussed and re-evaluated.

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Authors and Affiliations

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

    D. Vogt, S. G. Priglinger & R. G. Schumann

  2. Eye Clinic, Department of Biomedical and Clinical Science „Luigi Sacco“, Sacco Hospital, University of Milan, Milan, Italy

    F. Bottoni

Authors
  1. D. Vogt
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  2. F. Bottoni
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  3. S. G. Priglinger
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  4. R. G. Schumann
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Correspondence to D. Vogt.

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Interessenkonflikt

D. Vogt, F. Bottoni, S. G. Priglinger und R. G. Schumann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Vogt, D., Bottoni, F., Priglinger, S.G. et al. Makulaschichtforamen mit hyporeflektivem epiretinalem Gewebe. Ophthalmologe 114, 1100–1109 (2017). https://doi.org/10.1007/s00347-017-0597-5

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  • DOI: https://doi.org/10.1007/s00347-017-0597-5

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