Netzhautablösung im Kindesalter: Differenzialdiagnose und aktuelle Therapieoptionen

Zusammenfassung

Eine Ablatio retinae tritt im Kindesalter im Vergleich zum Erwachsenenalter relativ selten auf, nur ca. 3,2 – 6,6 % aller Netzhautablösungen werden bei Kindern diagnostiziert. Risikofaktoren für das Auftreten einer kindlichen Netzhautablösung sind ein Bulbustrauma, assoziierte Augapfelerkrankungen, Myopie und Retinopathia praematurorum (ROP) im Stadium 4 und 5 und im Spätstadium. Darüber hinaus werden sog. idiopathisch auftretende Netzhautablösungen beobachtet. Diese Kinder weisen keinerlei okuläre oder systemische Auffälligkeiten auf. Assoziierte Augapfelerkrankungen umfassen hereditäre vitreoretinale Erkrankungen (z. B. Morbus Stickler, X-chromosomale Retinoschisis, Marfan-Syndrom, familiär-exsudative Vitreoretinopathie), Malformationen (z. B. persistierender hyperplastischer primärer Vitreus [PHPV], Netzhaut-Aderhaut-Kolobom) und Netzhautablösungen infolge von Augenoperationen, vorrangig Linsenoperationen. Selten treten Netzhautablösungen in dieser Altersgruppe im Rahmen einer Uveitis oder bei Morbus Coats auf. Oftmals wird die Diagnose einer Netzhautablösung erst in einem Spätstadium gestellt, wenn bereits ausgeprägte Proliferationen ausgebildet sind. Kinder mit Risikofaktoren sollten deshalb einer intensiven augenärztlichen Kontrolle unterzogen werden. Trotz adäquater Folgebehandlung einer kindlichen Netzhautablösung resultieren schlechtere funktionelle und anatomische Ergebnisse im Vergleich zur Therapie einer Ablatio retinae im Erwachsenenalter. Eine Verbesserung der Prognose ist nur durch Ätiologie-spezifische Behandlungskonzepte denkbar. So gibt es Einzelberichte über den therapeutischen Einsatz von anti-angiogenen Substanzen bei ROP. Allerdings benötigen wir weitere Erkenntnisse über mögliche Nebenwirkungen und Komplikationen einer Therapie mit VEGF-Inhibitoren bei Frühgeborenen, da die unreife Netzhaut nicht der Retina eines Erwachsenen gleicht. Eine Therapie mit Anti-VEGF-Substanzen bei Frühgeborenen ist ohne kontrollierte Studien nicht zu empfehlen.

Abstract

The number of retinal detachments in children is very low in comparison to the number of retinal detachments in adults, only 3.2 – 6.6 % occur in children. The main predisposing factors are trauma, associated conditions, myopia and retinopathy of prematurity (ROP) i. e., stage 4 and 5 and late stage of ROP. Furthermore, retinal detachment in children can be idiopathic. These eyes are not associated with any identified ocular or systemic comorbidity. Associated conditions include hereditary vitreoretinal disorders (e. g., morbus Stickler, X-linked juvenile retinoschisis, Marfan syndrome, familiär exsudative vitreoretinopathy), malformations (e. g., persistent hyperplastic primary vitreous, coloboma) and retinal detachment following cataract surgery. In a few cases retinal detachment is caused by uveitis and by Coats disease. Delayed presentation and proliferative vitreoretinopathy are a common problem and in most eyes primary pars plana vitrectomy is necessary. It is important to perform consequent postoperative follow-up. The functional and anatomic outcomes of retinal detachment in children are less successful than in adults. Further surgical innovations and aetiology-specific treatment strategies are required to improve the outcome in this group. Recent results show that the intravitreal use of VEGF inhibitors to treat proliferative retinopathy (ROP) in children is effective, but we need further information about safety and side-effects.

Schlüsselwörter

Netzhautablösung - Kinderophthamologie - Differenzialdiagnose

Key words

retinal detachment - paediatric ophthalmology - differential diagnosis

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