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Optische Kohärenztomographie-Angiographie in der Intensivmedizin

Ein neues Einsatzgebiet?

Optical coherence tomography angiography in intensive care medicine

A new field of application?

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Zusammenfassung

Hintergrund

Bei vielen intensivmedizinischen Erkrankungen tritt eine Störung der Mikrozirkulation auf, die bisher noch nicht routinemäßig untersucht werden kann. Für Therapieentscheidungen und Prognoseeinschätzung würde eine Information über die Mikrozirkulation bei kritisch kranken Patienten jedoch von großem Interesse sein. Die optische Kohärenztomographie-Angiographie (OCTA) ermöglicht es, nichtinvasiv, kontaktlos und schnell den Blutfluss in der Mikrozirkulation der Retina darzustellen und hat daher möglicherweise das Potenzial, Störungen der Mikrozirkulation bei kritisch kranken Patienten zu diagnostizieren.

Fragestellung

Folgende Fragestellungen werden betrachtet: Stellenwert der Mikrozirkulation in der Intensivmedizin, Gegenüberstellung der Methoden der Videomikroskopie und der OCTA, Analyse der präklinischen und klinischen Daten zum Einsatz der OCTA bei intensivmedizinischen Krankheitsbildern.

Material und Methode

Es erfolgte eine selektive Literaturrecherche und Analyse der Daten.

Ergebnisse

Eine direkte Darstellung der Mikrozirkulation ist seit Jahren mithilfe der Videomikroskopie möglich, im klinischen Alltag aber aufgrund der Störanfälligkeit und zeitaufwendigen Auswertung nicht etabliert. Die OCTA ist ein nichtinvasives und kontaktloses Verfahren zur Darstellung des retinalen Blutflusses.

Schlussfolgerungen

Die OCTA als nichtinvasives Verfahren ist eine vielversprechende Messmethode, die eine bettseitige Analyse der Mikrozirkulation bei kritisch kranken Patienten zukünftig ermöglichen könnte. Hierzu sind allerdings noch einige technische Einschränkungen zu überwinden.

Abstract

Background

Many critically ill patients show a disturbance of the microcirculation, which is not yet regularly examined in the clinical routine; however, for treatment decisions and estimation of the prognosis it would be important to obtain detailed information about the microcirculation in critically ill patients. Optical coherence tomography angiography (OCTA) is a non-invasive, contact-free technique, which enables visualization of the blood flow in the retinal microcirculation within a few seconds. Therefore, it may have the potential to diagnose microcirculation disorders in critically ill patients.

Objective

The aims of the study were to assess the importance of the microcirculation in intensive care medicine, a comparison of the methods of video microscopy and OCTA and analysis of preclinical and clinical data on the use of OCTA in intensive care medicine.

Material and methods

A selective literature review and data analysis were carried out.

Results

A direct visualization of the microcirculation has been possible for many years with the technique of video microscopy but this has not become established in the clinical routine due to the susceptibility to interferences and a time-consuming manual analysis. The OCTA is a non-invasive and contact-free method for the visualization of retinal blood flow. First preclinical data in septic and hemorrhagic shock show good results of OCTA for analysis of the microcirculation.

Conclusion

The non-invasive technique of OCTA is a promising measurement method to enable bedside analysis of the microcirculation in critically ill paients in the future; however, some technical limitations must still be overcome.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland

    Michael Hessler,  Florian Lehmann,  Philip-Helge Arnemann &  Christian Ertmer

  2. Klinik für Augenheilkunde, Universitätsklinikum Münster, 48149, Münster, Deutschland

    Nicole Eter &  Maged Alnawaiseh

Authors
  1. Michael Hessler
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  2. Florian Lehmann
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  3. Philip-Helge Arnemann
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  4. Nicole Eter
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  5. Christian Ertmer
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  6. Maged Alnawaiseh
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Corresponding author

Correspondence to Michael Hessler.

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Interessenkonflikt

M. Hessler, F. Lehmann, P.-H. Arnemann, N. Eter, C. Ertmer und M. Alnawaiseh geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Die Autoren Dr. med. Michael Hessler und Dr. med. Florian Lehmann haben zu gleichen Teilen zum Manuskript beigetragen.

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Hessler, M., Lehmann, F., Arnemann, PH. et al. Optische Kohärenztomographie-Angiographie in der Intensivmedizin. Ophthalmologe 116, 728–734 (2019). https://doi.org/10.1007/s00347-019-0893-3

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