Vaskuläre Biomarker der retinalen Gefäßanalyse

Zusammenfassung

Mit modernen nicht invasiven bildgebenden Verfahren lassen sich anhand der Fundusfotografie bzw. der optischen Verfilmung Aspekte der funktionellen und strukturellen retinalen Gefäßveränderungen objektiv untersuchen. Der Zustand und das Verhalten retinaler Gefäße beeinflussen im prä-, post- und kapillaren Bereich den Blutfluss und strömungsbedingte Stoffwechselverhältnisse passiv und aktiv über den Gefäßdurchmesser. Retinale Gefäße gleichen von Aufbau und Funktion den zerebralen Gefäßen und spiegeln den Zustand der Mikrozirkulation wider. Mithilfe von aus den Gefäßweiten berechneten Biomarkern soll eine Aussage über die Prognose von systemischen vaskulär bedingten Erkrankungen getroffen werden. Die statische retinale Gefäßanalyse befasst sich mit der Untersuchung des Zustandes der prä- und postkapillaren Gefäßdurchmesser der retinalen Mikrozirkulation anhand einer optischen Fundusaufnahme. Bei der dynamischen retinalen Gefäßanalyse wird der Längsschnitt eines retinalen Gefäßes nicht invasiv funktionell und strukturell über einen Zeitraum vor, während und nach einer spezifischen vaskulären Stimulation untersucht. Die genaue Methodologie der Auswertung und die Bezeichnung der Parameter variieren bei unterschiedlichen Ansätzen. Mittels retinaler Gefäßanalyse wurden bislang mehrere klinische Querschnitts- und Interventionsstudien in der Augenheilkunde und anderen Fachgebieten, inkl. Kardiologie, Neurologie, Neurochirurgie, Nephrologie, Gynäkologie, Sportmedizin, Diabetologie, Hypertensiologie usw. durchgeführt. Mit der statischen retinalen Gefäßanalyse steht eine kostengünstige, reproduzierbare, nicht invasive Screeningtechnik zur Verfügung, um eine prognostische Aussage über die Gefäßgesundheit eines individuellen Patienten zu treffen. Die dynamische retinale Gefäßanalyse besitzt ein weiteres diagnostisches Anwendungsspektrum als die statische, da sie das Verhalten retinaler Gefäße zeitkontinuierlich untersucht. Die Evaluation vaskulärer Erkrankungen sowie zerebro- bzw. kardiovaskulärer Morbidität und Mortalität mittels mehrerer methodologischer Modalitäten retinaler Gefäßanalyse mit ihren jeweiligen quantitativen Biomarkern bietet eine zukunftsträchtige diagnostische Perspektive. Die interdisziplinäre klinische Anwendung dieser vaskulären Biomarker gewinnt zunehmend an Bedeutung, sowohl in der Augenheilkunde als auch in anderen Fachgebieten.

Abstract

Modern non-invasive imaging procedures – including fundus photography and optical filming – can be used to investigate objective aspects of changes in the function and structure of retinal vessels. In the pre-, post- and capillary areas, the status and behaviour of retinal vessels passively and actively influence blood flow and flow-related metabolism through changes in vascular diameter. Retinal vessels have the same structure and function as cerebral vessels and reflect the status of the microcirculation. In dynamic retinal vessel analysis, the function and structure of the longitudinal section of retinal vessels are subjected to a non-invasive functional and structural examination over a period before, during and after a specific vascular stimulation. The exact methodology of the evaluation and the designation of the parameters depend on the investigation. Retinal vessel analysis has been employed in several cross-sectional and interventional clinical studies in ophthalmology and other specialities, including cardiology, neurology, neurosurgery, nephrology, gynaecology, sports medicine, diabetology, hypertensiology and others. Static retinal vessel analysis is an inexpensive, reproducible, non-invasive technique, which can be used to make a prognostic statement on the vascular health of an individual patient. Dynamic retinal vessel analysis possesses a broader spectrum of diagnostic applications than the static procedure, as it examines changes in vessel diameter continuously over time. The use of several different methodological modalities for retinal vessel analysis together with their relevant quantitative biomarkers represents a promising approach for the evaluation of vascular diseases and cerebro- or cardiovascular morbidity and mortality. Interdisciplinary clinical application of these vascular biomarkers is becoming increasingly important in ophthalmology and other specialities.

Schlüsselwörter

Retina - Pathologie - physiologische Optik - Informationstechnologie

Key words

retina - pathology - physiological optics - information technology

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