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Klin Monbl Augenheilkd 2018; 235(11): 1242-1258
DOI: 10.1055/a-0715-7961
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Optische Kohärenztomografie bei Erkrankungen des zentralen Nervensystems

Optical Coherence Tomography in Disorders of the Central Nervous System
Athina Papadopoulou
1   NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
2   Neurologie, Universitätsspital Basel, Schweiz
,
Frederike Cosima Oertel
1   NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
,
Hanna Zimmermann
1   NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
,
Oliver Zeitz
3   Klinik für Augenheilkunde, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
,
Alexander U. Brandt
1   NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
4   Neurology, University of California Irvine School of Medicine, Irvine, California, United States
,
Friedemann Paul
1   NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
5   Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
6   Klinik für Neurologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
› Author Affiliations
Further Information

Publication History

eingereicht 01 June 2018

akzeptiert 20 August 2018

Publication Date:
20 November 2018 (online)

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Zusammenfassung

Inflammatorische, degenerative und tumoröse Erkrankungen des zentralen Nervensystems (ZNS) gehen häufig mit Veränderungen am Augenhintergrund und Sehstörungen einher. Mit der optischen Kohärenztomografie (OCT) hat erstmals eine Methode Einzug in das neuroophthalmologische Methodenspektrum gehalten, die das strukturelle Korrelat dieser Sehstörungen quantitativ und für den klinischen Alltag praktikabel erfassen kann. Das auf Interferometrie beruhende, nicht invasive Verfahren ist in der Lage, hochaufgelöste Volumenaufnahmen der Retina aufzunehmen und die Dicke bzw. das Volumen einzelner Schichten der Netzhaut zu messen. Insbesondere die pRNFL (peripapilläre retinale Nervenfaserschicht) und GCIPL (Ganglienzellschicht und innere plexiforme Schicht zusammen) sind in der Neurologie von großem Interesse, da sie Axone und zugehörige Nervenzellen enthalten, die im weiteren Verlauf den Sehnerv bilden. Bei einer akuten Optikusneuritis (ON) kann eine initiale Schwellung der pRNFL zur Diagnose und Differenzialdiagnose der ON und eine Verdünnung der GCIPL während der ersten 4 Wochen zur Prognose der Visuserholung beitragen. Bei der multiplen Sklerose (MS) ist die Rolle der OCT nicht nur in Zusammenhang mit der ON zu sehen. Auch MS-Augen ohne ON zeigen eine Verdünnung der pRNFL und GCIPL, die mit neurodegenerativen Prozessen im gesamten ZNS korreliert. Mehrere Studien haben Korrelationen zwischen diesen OCT-Parametern und dem Risiko für eine klinische Verschlechterung (Behinderungsprogression), kognitive Defizite, aber auch Krankheitsaktivität bei MS gezeigt, wobei es häufig noch unklar ist, wie dieser Zusammenhang in der Behandlung des individuellen Patienten nutzbar gemacht werden kann. OCT ist in den letzten Jahren zunehmend auch bei neurodegenerativen Erkrankungen wie Morbus Parkinson, amyotropher Lateralsklerose und diversen Demenzformen eingesetzt worden. Ein Einsatz in der klinischen Routine ist jedoch noch in deutlich weiterer Ferne als bei entzündlichen ZNS-Erkrankungen, da der klinische Stellenwert von OCT für Diagnostik, Differenzialdiagnostik und Prädiktion bzw. Verlaufsbeurteilung bislang nicht geklärt ist. Dieser Übersichtsartikel soll einen Überblick über die aktuelle Studienlage zu OCT-Parametern und deren Bedeutung bei inflammatorischen, degenerativen und tumorösen Erkrankungen des zentralen Nervensystems schaffen.

Abstract

Retinal changes and visual symptoms are present in several inflammatory, degenerative and tumorous disorders of the central nervous system (CNS). Optical coherence tomography (OCT) is a method that can be used in clinical practice to detect and quantify the structural correlates of these visual symptoms in neurological disorders. OCT is a non-invasive imaging technique, based on interferometry, which can create high-resolution images of the retina and measure the thickness and volume of the different retinal layers. The combined ganglion cell- and inner plexiform layer (GCIPL) and the peripapillary retinal nerve fibre layer (pRNFL) are of particular interest in the field of neurological disorders, since they contain the neuronal bodies (ganglion cells) and their axons that form the optic nerve. In acute optic neuritis (ON), initial swelling of the pRNFL can be detected by OCT and this may contribute to the diagnosis and differential diagnosis of ON; moreover, the extent of the GCIPL-thinning within the first 4 weeks after an acute ON can contribute to the prediction of the long-term visual recovery. However, the role of OCT in the field of multiple sclerosis (MS) is not restricted in patients with ON, since even eyes without an ON-history show mild thinning of the pRNFL and GCIPL. This thinning seems to be associated with neurodegenerative processes in the entire CNS. Several studies showed correlations between these OCT-parameters and a higher risk of clinical deterioration (disability progression), cognitive deficits and disease activity in patients with MS. However, it is often still unclear how these correlations can be useful in the management of the individual patient. In recent years, OCT has been applied to a greater extent to neurodegenerative diseases, such as Parkinsonʼs disease, amyotrophic lateral sclerosis (ALS) and various forms of dementia. However, routine clinical use is still further away than for inflammatory CNS diseases, since the role of OCT in the diagnosis, differential diagnosis and prediction of the clinical course of neurodegenerative diseases is still unclear. This review article offers a summary of the available study results on OCT parameters and their role in inflammatory, degenerative and tumorous diseases of the central nervous system (CNS).

Schlüsselwörter

Optikusneuritis - Neuroimmunologie - Neurodegeneration - Neuroophthalmologie - Retina - multiple Sklerose

Key words

optic neuritis - neuroophthalmology - neuroimmunology - retina - multiple sclerosis - neurodegeneration
 

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