Ultraweitwinkel-Fundusfotografie und -angiografie in der Differenzialdiagnose und zur Therapieplanung bei peripheren vaskulären Netzhauterkrankungen

Zusammenfassung

Bei vaskulären Erkrankungen der Netzhautperipherie ist eine Bildgebung, die einen umfassenden Einblick in die periphere Netzhaut ermöglicht und diese reproduzierbar abbilden kann, von hoher klinischer Relevanz. Die Weitwinkelangiografie ist in der Differenzialdiagnose peripherer vaskulärer Netzhauterkrankungen insbesondere zur Therapieentscheidung und Verlaufsbeurteilung wertvoll. Da Erkrankungen wie Morbus Coats und die familiär exsudative Vitreoretinopathie meist innerhalb der 1. oder Anfang der 2. Lebensdekade diagnostiziert werden, ist bei den meisten Patienten mit unzureichender Compliance bei Fundusaufnahmen zu rechnen. Gerade hier ermöglicht die Ultraweitwinkelbildgebung eine deutlich kürzere Aufnahmezeit im Vergleich zu Kompositaufnahmen. Dennoch können auch die aktuellsten Systeme nicht die gesamte Netzhaut vollständig abbilden. Der Bildausschnitt muss daher gezielt durch Blickrichtungen zum betroffenen Areal gelenkt werden und dem Fotografen die klinische Fragestellung stets zu Beginn der Aufnahmen bewusst sein. Daher steht nach wie vor eine gründliche Funduskopie in Mydriasis durch den erfahrenen Augenarzt an erster Stelle.

Abstract

Investigation of vascular diseases of the peripheral retina requires imaging procedures that allow a comprehensive view of the periphery, as well as reproducible pictures. In particular, ultra-wide field fluorescence angiography facilitates diagnosis, therapeutic decisions and follow-up examinations. While vasculopathies such as Coats disease and familiar exudative vitreoretinopathy are diagnosed within the first and second decade of life, patientsʼ compliance during fundus imaging is typically reduced within this age range. Compared to the repeated imaging procedures for composite formation, ultra-wide field imaging has significantly reduced recording time. Nevertheless, current imaging systems are not able to map the entire retina in scaled proportions. Therefore, the imaging frame must be guided by patientsʼ gaze onto the affected retinal area. Moreover, the medical photographer must be aware of the clinical setting and the region of interest. Hence, previous detailed funduscopy by trained ophthalmologists will remain indispensable.

Schlüsselwörter

familiär exsudative Vitreoretinopathie - Hämangioblastom - Morbus Coats - vasoproliferative retinale Tumoren - Weitwinkelangiografie - Weitwinkelbildgebung

Key words

familiar exudative vitreoretinopathy - hemangioblastoma - coats disease - vasoproliferative retinal tumor - ultra-wide field angiography - ultra-wide field imaging

• Literatur

• 1 Lorenz B, Stieger K, Jäger M. et al. Retinal Vascular Development With 0.312 mg Intravitreal Bevacizumab To Treat Severe Posterior Retinopathy Of Prematurity: A Longitudinal Fluorescein Angiographic Study. Retina 2017; 37: 97-111
• 2 Kumar V, Chandra P, Kumar A. Ultra-wide field angiography in the management of Eales disease. Indian J Ophthalmol 2016; 64: 504-507
• 3 Busch C, Löwen J, Pilger D. et al. Quantification of radiation retinopathy after beam proton irradiation in centrally located choroidal melanoma. Graefes Arch Clin Exp Ophthalmol 2018; DOI: 10.1007/s00417-018-4036-3.
• 4 Nürnberg D, Seibel I, Riechardt AI. et al. Multimodale Bildgebung des Aderhautmelanoms mit seinen Differenzialdiagnosen, Therapie (Bestrahlungsplanung) und Verlaufskontrolle. Klin Monatsbl Augenheilkd 2018; 235: 1002-1013
• 5 Mintz-Hittner HA, Kennedy KA, Chuang AZ. Efficacy of intravitreal bevacizumab for stage 3+ retinopathy of prematurity. N Engl J Med 2011; 364: 603-615
• 6 Mueller B, Salchow DJ, Waffenschmidt E. et al. Treatment of type I ROP with intravitreal bevacizumab or laser photocoagulation according to retinal zone. Br J Ophthalmol 2017; 101: 365-370
• 7 Hajrasouliha AR, Garcia-Gonzales JM, Shapiro MJ. et al. Reactivation of Retinopathy of Prematurity Three Years After Treatment With Bevacizumab. Ophthalmic Surg Lasers Imaging Retina 2017; 48: 255-259
• 8 Henaine-Berra A, Garcia-Aguirre G, Quiroz-Mercado H. et al. Retinal fluorescein angiographic changes following intravitreal anti-VEGF therapy. J AAPOS 2014; 18: 120-123
• 9 Lepore D, Quinn GE, Molle F. et al. Follow-up to Age 4 Years of Treatment of Type 1 Retinopathy of Prematurity Intravitreal Bevacizumab Injection versus Laser: Fluorescein Angiographic Findings. Ophthalmology 2018; 125: 218-226
• 10 Geloneck MM, Chuang AZ, Clark WL. et al. Refractive outcomes following bevacizumab monotherapy compared with conventional laser treatment: a randomized clinical trial. JAMA Ophthalmol 2014; 132: 1327-1333
• 11 Hwang CK, Hubbard GB, Hutchinson AK. et al. Outcomes after Intravitreal Bevacizumab versus Laser Photocoagulation for Retinopathy of Prematurity: A 5-Year Retrospective Analysis. Ophthalmology 2015; 122: 1008-1015
• 12 Park KH, Hwang JM, Choi MY. et al. Retinal detachment of regressed retinopathy of prematurity in children aged 2 to 15 years. Retina 2004; 24: 368-375
• 13 Joussen AM, Gordes RS, Heußen FA. et al. [Retinal exudative disease in childhood: Coatsʼ disease and familial exudative vitreoretinopathy (FEVR)]. Klin Monatsbl Augenheilkd 2013; 230: 902-913
• 14 Kashani AH, Brown KT, Chang E. et al. Diversity of retinal vascular anomalies in patients with familial exudative vitreoretinopathy. Ophthalmology 2014; 121: 2220-2227
• 15 Spitznas M, Joussen F, Wessing A. Treatment of Coatsʼ disease with photocoagulation. Albrecht Von Graefes Arch Klin Exp Ophthalmol 1976; 199: 31-37
• 16 Shields CL, Shields JA, Barrett J. et al. Vasoproliferative tumors of the ocular fundus. Classification and clinical manifestations in 103 patients. Arch Ophthalmol 1995; 113: 615-623
• 17 Damato B. Vasoproliferative retinal tumour. Br J Ophthalmol 2006; 90: 399-400
• 18 Heimann H, Bornfeld N, Vij O. et al. Vasoproliferative tumours of the retina. Br J Ophthalmol 2000; 84: 1162-1169
• 19 Irvine F, OʼDonnell N, Kemp E. et al. Retinal vasoproliferative tumors: surgical management and histological findings. Arch Ophthalmol 2000; 118: 563-569
• 20 Smeets MH, Mooy CM, Baarsma GS. et al. Histopathology of a vasoproliferative tumor of the ocular fundus. Retina 1998; 18: 470-472
• 21 Hiscott P, Mudhar H. Is vasoproliferative tumour (reactive retinal glioangiosis) part of the spectrum of proliferative vitreoretinopathy?. Eye (Lond) 2009; 23: 1851-1858
• 22 Baines PS, Hiscott PS, McLeod D. Posterior non-vascularized proliferative extraretinopathy and peripheral nodular retinal telangiectasis. Trans Ophthalmol Soc U K 1982; 102: 487-491
• 23 Laqua H, Wessing A. Peripheral retinal telangiectasis in adults simulating a vascular tumor or melanoma. Ophthalmology 1983; 90: 1284-1291
• 24 Bornfeld N. Vascular Tumors of the Retina. In: Joussen AM. ed. Retinal vascular Disease. Berlin, Heidelberg, New York: Springer; 2010: 446-449
• 25 Anastassiou G, Bornfeld N, Schueler AO. et al. Ruthenium-106 plaque brachytherapy for symptomatic vasoproliferative tumours of the retina. Br J Ophthalmol 2006; 90: 447-450
• 26 Kitei PM, Say EA, Shields CL. et al. Management of Retinal Vasoproliferative Tumor Associated with ROP by Plaque Brachytherapy. J Pediatr Ophthalmol Strabismus 2011; 48: e10-e12
• 27 Brockmann C, Rehak M, Heufelder J. et al. Predictors of treatment response of vasoproliferative retinal tumors to Ruthenium-106 brachytherapy. Retina 2016; 36: 2384-2390
• 28 Seibel I, Nürnberg D, Löwen J. et al. Peripher exsudative hämorrhagische Chorioretinopathie: Krankheitsverlauf, Diagnosestellung inklusive Weitwinkelbildgebung der assoziierten Erkrankungen altersabhängige Makuladegeneration und polypoidale Choriovaskulopathie, Therapie. Klin Monatsbl Augenheilkd 2018; 235: 995-1001
• 29 Varshney N, Kebede AA, Owusu-Dapaah H. et al. A Review of Von Hippel-Lindau Syndrome. J Kidney Cancer VHL 2017; 4: 20-29
• 30 Lonser RR, Glenn GM, Walther M. et al. von Hippel-Lindau disease. Lancet 2003; 361: 2059-2067
• 31 Nielsen SM, Rhodes L, Blanco I. et al. Von Hippel-Lindau Disease: Genetics and Role of Genetic Counseling in a Multiple Neoplasia Syndrome. J Clin Oncol 2016; 34: 2172-2181
• 32 Gaudric A, Krivosic V, Duguid G. et al. Vitreoretinal surgery for severe retinal capillary hemangiomas in von Hippel-Lindau disease. Ophthalmology 2011; 118: 142-149
• 33 Avci R, Yilmaz S, Inan UU. et al. Vitreoretinal surgery for patients with severe exudative and proliferative manifestations of retinal capillary hemangioblastoma because of von Hippel-Lindau disease. Retina 2017; 37: 782-788
• 34 Shah GK, Shields JA, Lanning RC. Branch retinal vein obstruction secondary to retinal arteriovenous communication. Am J Ophthalmol 1998; 126: 446-448
• 35 Elliot AJ. 30-year observation of patients with Ealeʼs disease. Am J Ophthalmol 1975; 80: 404-408
• 36 Das T, Pathengay A, Hussain N. et al. Ealesʼ disease: diagnosis and management. Eye (Lond) 2010; 24: 472-482