Zusammenfassung
Die Technik der optischen Kohärenztomografie scheint bei Glaukomen mittlerweile unverzichtbar
für Dokumentation, Diagnosehilfestellung und Verlaufsbeobachtung. Die kritisch betrachteten
Befunde sollten immer in Übereinstimmung mit dem klinischen Bild des Patienten gesehen
werden. Der Artikel zeigt die Einsatzmöglichkeiten anhand von Fallbeispielen.
Abstract
High-resolution optical coherence tomography (OCT) with spectral-domain or swept-source
techniques has become a mainstay in glaucoma and progression diagnosis. Imaging and
morphometry of ganglion cell (GCL) and retinal nerve fiber (RNF) layer thickness and
Bruchʼs membrane based minimum neuroretinal rim width (BMO-MRW) measurement allow
the detection of pathologic changes. Graphic display of these measurements facilitate
a comparison with normative data. False positive (red disease) and false negative
(green disease) results represent pitfalls in OCT diagnosis. Pathologies of the posterior
pole either caused by glaucoma or non-glaucoma associated changes of optic disc and
retina play an important role. Epiretinal gliosis, age related macular degeneration
and cystoid retinal changes cause measuring artefacts. A careful inspection of OCT
B-scans is mandatory to detect these changes. Highly myopic eyes, underrepresented
in normative databases cause changes resembling glaucoma and challenge the OCT glaucoma
diagnosis. Neurological diseases present an important differential diagnosis when
atrophy of neuroretinal tissue and ganglion cells occur. The location of the atrophy
and the relationship of GCL, RNF and BMO-MRW changes may help in differential diagnosis.
Sensory tests and imaging of the brain are mandatory in these cases. Drusen and disc
edema cause thickening of BMO-MRW and may be followed by loss of RNF and GCL. Again
a close observation of OCT B-scans and fundus may help to find the correct diagnosis.
Good image quality, knowledge of OCT pathologies and technique of OCT imaging may
help to avoid pitfalls in OCT glaucoma diagnosis.
Schlüsselwörter
Glaukom - OCT - Makula - Retina
Key words
OCT - glaucoma - differential diagnosis - RNF - BMO-MRW
