Zusammenfassung
Der akute Zentralarterienverschluss (ZAV) ist eine ophthalmologische Notfallsituation.
Die häufigsten Risikofaktoren sind eine arterielle Hypertonie, Herzrhythmusstörungen,
Arteriosklerose, Hypercholesterinämie und Diabetes mellitus. Besonders bei älteren
Patienten muss eine arteriitische Genese ausgeschlossen werden. Bei jungen Patienten
(< 45 Jahre) ohne typische Risikofaktoren kann eine Thrombophilieabklärung sinnvoll
sein. Für den nicht arteriitischen ZAV existiert keine einheitliche Therapieempfehlung.
In der Literatur findet man zahlreiche Ansätze. Dazu zählen die Bulbusmassage, die
systemische oder lokale Senkung des Augeninnendrucks, die Antikoagulation, die venöse
systemische Lysetherapie und die kathetergeführte superselektive intraarterielle Lyse.
In diesem Übersichtsartikel sollen sowohl die Ursachen des ZAV, die diagnostischen
Maßnahmen zur Erkennung der Ursachen als auch die in der Literatur beschriebenen Therapieformen
vorgestellt und kritisch bewertet werden. Ziel ist es, eine Orientierung über die
notwendigen Schritte zur interdisziplinären Diagnostik in Kooperation mit Internisten
und Neurologen und über die multimodale Therapie bei Patienten mit nicht arteriitischem
ZAV zu geben.
Abstract
Central retinal artery occlusion (CRAO) is an ophthalmological emergency situation.
Known risk factors are arterial hypertension, cardial arrhythmia, arteriosclerosis,
hypercholesterolemia and diabetes. Elderly patients should be examined for an arteritic
genesis. Young patients (< 45 years) without typical risk factors may suffer from
thrombophilia. There is no uniform recommendation on how to treat non-arteritic CRAO.
Many different interventions have been suggested in the literature, i. e., massaging
the eye, systemic or local reduction of intraocular pressure, anticoagulation, either
systemically administered venous thrombolysis or supraselective intra-arterial thrombolysis.
In this review we present the causes of CRAO and diagnostic means to detect causes;
we also critically discuss previously described therapeutic options. It is our aim
to provide a guide through the necessary interdisciplinary diagnostics in co-operation
with internal medicine and neurology and to recommend a multimodal therapy in patients
with non-arteritic CRAO.
Schlüsselwörter
Retina - Pathologie - Zentralarterienverschluss - Diagnostik - Therapie
Key words
retina - pathology - central retinal artery occlusion - clinical diagnostics - therapy
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Dr. Amelie Pielen
Universitäts-Augenklinik
Killianstraße 5
79106 Freiburg
Telefon: ++ 49/7 61/2 70 40 01
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eMail: amelie.pielen@uniklinik-freiburg.de
