Diffuse retinale Pigmentepitheliopathie unter systemischer Therapie mit Kortikosteroiden[1] [2]

Zusammenfassung

Hintergrund Sowohl nach lokaler als auch nach systemischer Kortikosteroidbehandlung kann es zu okulären Nebenwirkungen kommen. Neben den häufigen Nebenwirkungen wie Entwicklung einer Katarakt und Erhöhung des intraokularen Druckes, kann es in seltenen Fällen zu einer diffusen retinalen Pigmentepitheliopathie kommen.

Patient Ein 64-jähriger Patient stellte sich mit erheblicher Visusminderung an beiden Augen vor. Diese hatte sich innerhalb von 6 Wochen langsam entwickelt. Die ophthalmologische Untersuchung zeigte beiderseits eine massive diffuse retinale Pigmentepitheliopathie mit seröser Abhebung der neurosensorischen Netzhaut. Der Patient wurde wegen einer chronischen Glomerulonephritis seit längerer Zeit mit Methylprednisolon behandelt. Nach Absetzten dieser systemischen Steroidtherapie kam es zum deutlichen Visusanstieg und zur Rückbildung der serösen Abhebung der neurosensorischen Netzhaut.

Schlußfolgerung Patienten, die über längere Zeit mit Steroiden behandelt werden, sollten deshalb regelmäßig ophthalmologisch untersucht werden. Bei Vorliegen einer Pigmentepitheliopathie sollte, wenn möglich, die Steroidtherapie reduziert bzw. vollständig abgesetzt werden.

Background It is well known that topical as well as systemic treatment with corticosteroids may have ocular side effects. The most common are the development of cataract and increase of intraocular pressure, however, alteration of the retinal pigment epithelium may also occur.

Patient A 64-year old male experienced a progressive decrease of visual acuity over a time period of 6 weeks. Ophthalmologic examination revealed a severe diffuse retinal pigment epitheliopathy with serous detachment of the neurosensory retina. This patient was treated with systemic methylprednisolone for chronic glomerulonephritis. After cessation of the treatment with systemic corticosteroids visual acuity improved and the serous retinal detachment resolved.

Conclusion Ophthalmologic examination including biomicroscopy of the retina is recommended on a regular basis for patients treated with systemic corticosteroids. With development of pigment epithelial changes steroids should be reduced or discontinued if possible.

Schlüsselwörter

Aderhaut - Blut-Retina-Schranke - diffuse retinale Pigmentepitheliopathie - Kortikosteroide - Makulopathie - retinales Pigmentepithel - zentrale seröse Chorioretinopathie

Key words

Blood retinal barrier - corticosteroid - central serous chorioretinopathy - diffuse retinal pigment epitheliopathy - maculopathy

1 Manuskript eingereicht am 9. 2. 00 und in der vorliegenden Form angenommen.

2 Herrn Prof. Dr. G. O. H. Naumann gewidmet.

Literatur

1 Manuskript eingereicht am 9. 2. 00 und in der vorliegenden Form angenommen.

2 Herrn Prof. Dr. G. O. H. Naumann gewidmet.

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