Brauchen wir noch Elektrophysiologie in der Augenheilkunde? Indikationsstellung für elektrophysiologische Untersuchungen

H. Tegetmeyer

doi:10.1055/s-0042-119298

Klinische Monatsblätter für Augenheilkunde, Inhaltsverzeichnis

Klin Monbl Augenheilkd 2016; 233(12): 1339-1349
DOI: 10.1055/s-0042-119298

Übersicht

Georg Thieme Verlag KG Stuttgart · New York

Brauchen wir noch Elektrophysiologie in der Augenheilkunde? Indikationsstellung für elektrophysiologische Untersuchungen

Do We Still Need Electrophysiology in Ophthalmology?

H. Tegetmeyer

Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig AöR

› Institutsangaben

Abstract

Zusammenfassung

Als elektrophysiologische Untersuchungsmethoden in der Augenheilkunde stehen das Ganzfeld-Elektroretinogramm (ERG) zur Untersuchung der äußeren und mittleren Netzhautschichten, das Muster-ERG (PERG) zur Untersuchung der Ganglienzellfunktion, das Elektrookulogramm (EOG) zur Untersuchung der Funktion des retinalen Pigmentepithels sowie visuell evozierte Potenziale (VEP) zur Prüfung der gesamten Sehbahn einschließlich des N. opticus und des primären visuellen Kortexes zur Verfügung. ERG und VEP können auch multifokal zur Testung innerhalb umschriebener Gesichtsfeldareale eingesetzt werden. Die technische Entwicklung bildgebender Verfahren, insbesondere der optischen Kohärenztomografie (OCT) und der Fundusautofluoreszenz (FAF) hat es möglich gemacht, feine morphologische Veränderungen im Bereich der Netzhaut mit hoher räumlicher Auflösung zu erfassen. Dadurch lassen sich vielfach typische retinale Erkrankungen frühzeitig erkennen, deren Diagnose bisher den Einsatz elektrophysiologischer Untersuchungen erforderte (z. B. X-chromosomale Retinoschisis, Morbus Stargardt, vitelliforme Makuladystrophie). Die OCT ist elektrophysiologischen Methoden bei der Quantifizierung einer Optikusatrophie deutlich überlegen. Mithilfe neu entwickelter optischer Verfahren gelingt es zunehmend besser, auch periphere Netzhautstrukturen (Weitwinkeloptik) und feine Strukturen bis zur Photorezeptorebene (adaptive Optik) darzustellen. Allerdings erlaubt es bisher nur die elektrophysiologische Diagnostik, zentrale Netzhauterkrankungen (z. B. Makuladystrophie) von generalisierten Netzhauterkrankungen (z. B. Zapfendystrophie, Retinitis pigmentosa) sicher abzugrenzen und Funktionsstörungen bei generalisierten Netzhauterkrankungen (z. B. Enhanced-S-Cone-Syndrom, kongenitale stationäre Nachtblindheit, Achromatopsie) zu unterscheiden.

Abstract

Electrophysiological methods in clinical ophthalmology include the full-field electroretinogram (ERG) for assessment of outer and middle retinal layers, pattern ERG (PERG) for assessment of ganglion cell function, the electrooculogram (EOG) for assessment of retinal pigment epithelium function, as well as visual evoked potentials (VEP) for assessment of the visual pathway, including the optic nerve and visual cortex. Multifocal recording techniques for ERG and VEP are used for tests within selected areas of the visual field. Technical progress in ocular imaging, especially optical coherence tomography (OCT) and fundus autofluorescence (FAF), allows high-resolution imaging of subtle morphological changes of the retina and posterior fundus. Typical retinal diseases may then be diagnosed at an early stage, without conventional electrophysiological investigations (e.g. x-linked retinoschisis, Stargardt disease, vitelliform macular dystrophy). OCT outclasses electrophysiological methods in the quantification of optic atrophies. With newly developed optic techniques, peripheral retinal structures (wide angle optics) and subtle structures up to the photoreceptor level (adaptive optics) can be imaged with increasing quality. However, differentiation of central retinal disorders (e.g. macular dystrophy) from generalised retinal diseases requires electrophysiological diagnostic testing. The same applies to discrimination between different functional disorders in generalised retinal diseases (e.g. enhanced S-cone syndrome, congenital stationary night blindness, achromatopsia).

Schlüsselwörter

Elektrophysiologie - Retina - OCT - ERG - Fundusautofluoreszenz

Key words

electrophysiology - retina - OCT - ERG - fundus autofluorescence

Volltext

Referenzen

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