Zusammenfassung
Die diabetische Retinopathie (DR) ist die häufigste Ursache für schwere Sehbehinderung
und Erblindung im erwerbstätigen Alter. Eine subjektive Beeinträchtigung des Sehvermögens
tritt häufig erst in fortgeschrittenen Stadien der DR ein. Daher sind Screening-Maßnahmen
asymptomatischer Patienten und eine stadiengerechte Behandlung essenziell. Dieser
Beitrag gibt einen praxisbezogenen Überblick über diagnostische und therapeutische
Prinzipien der nicht-proliferativen und proliferativen Form.
Abstract
Diabetic retinopathy (DR) is a vision-threatening microvascular complication of diabetes
and the leading cause of blindness in working-age people. At the beginning of the
metabolic disorder and in early stages of DR the patientʼs eyesight is often not affected.
Depending on the duration of diabetes and in more advanced stages of DR the vision
is compromised through the presence of diabetic macular edema (DME) and/or proliferative
retinal complications. The management of DR comprises regular ophthalmic examinations
according to clinical guidelines, the targeted application of multimodal imaging,
and the specific treatment of DME and proliferative DR including secondary disorders
such as neovascular glaucoma or persistent vitreous haemorrhage. Innovative ocular
imaging techniques like optical coherence tomography (OCT), OCT angiography (OCT-A)
and ultrawide field imaging play an important role in the assessment of diabetic patients.
Various non-invasive imaging modalities
have become part of the routine clinical work-up and help to identify new biomarkers
for early diagnosis and long-term prognosis. In early stages of DR, the multifactorial
intervention including glucose level and blood pressure control as well as optimizing
the patientʼs cardiovascular risk profile is essential. A specific ophthalmic therapy
is available for DME and proliferative DR (PDR). In patients with PDR the treatment
regime includes panretinal laser photocoagulation or alternatively intravitreal anti-VEGF
(vascular endothelial growth factor)-injections accompanied by close-meshed clinical
monitoring. In patients with both, DME and PDR, it is suggested to start with Anti-VEGF
drugs. In severe PDR with persistent vitreous haemorrhage, tractional maculopathy
or tractional retinal detachment vitreoretinal surgery is recommended.
Schlüsselwörter
Diabetes - Netzhaut - Retinopathie - Angiografie - Laserphotokoagulation
Key words
diabetes - retina - retinopathy - angiography - laser photocoagulation
