Der retinale Arterienverschluss

Der retinale Arterienverschluss (RAV) ist eine der visusbedrohendsten Augenerkrankungen. Die meisten Betroffenen erleben einen dramatischen, einseitigen und schmerzlosen Visusverlust, der bis zur Erblindung führen kann. Bislang gibt es keine kausale Therapie und deshalb aktuell auch keine Behandlungspflicht. Die intravenöse Fibrinolysetherapie wird derzeit in klinischen Studien untersucht, ein gesicherter Nutzen ist jedoch noch nicht belegt.

Abstract

Retinal artery occlusion (RAO) remains one of the most vision-threatening conditions in ophthalmology. Most patients experience a dramatic, unilateral and painless loss of vision, which can lead to blindness. No causal therapy has yet been established, which is why there is currently no obligation to treat. Intravenous fibrinolysis therapy is currently being investigated in clinical trials and is the most promising option to date, but its benefits have not yet been proven. This therapy is established for ischaemic stroke but is based on the very narrow 4.5-hour time window which is comparable to stroke therapy. This time window has not yet been definitively established for RAV, but clinically every minute counts. Emergency admission to a neurological clinic is recommended, as there is an increased risk of further embolic and ischaemic events. Even though underlying giant cell arteritis (GCA) is rare, GCA must always be considered as a possible cause.

Kernaussagen

• Der retinale Arterienverschluss ist nach wie vor eine Erkrankung ohne nachgewiesen effektive Therapie.

• Die zugrunde liegenden Emboliequellen müssen rasch gefunden und behandelt werden, um weitere Verschlussereignisse zu verhindern. Deshalb ist die direkte Einweisung in eine neurologische Klinik oder auf eine Stroke-Unit empfehlenswert.

• Die Diagnose sollte möglichst schnell, idealerweise innerhalb der ersten 4,5 Stunden nach Symptombeginn erfolgen, damit ein Behandlungsversuch unternommen werden kann.

• Die Hoffnungen ruhen weiterhin auf der intravenösen Fibrinolyse mit Tenecteplase, hierzu wird aktuell die europäische REVISION-Studie durchgeführt (https://revision-trial.de/).

Schlüsselwörter

Schlaganfall - Sehverschlechterung - Blindheit - Gesichtsfeldverlust - Fibrinolyse

Keywords

stroke - visual impairment - blindness - visual field loss - fibrinolysis

Publication History

Article published online:
17 February 2026

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