Inflammatorische choroidale Neovaskularisationen

Zusammenfassung

Da die Entzündung eine wichtige Rolle bei der Induktion von choroidalen Neovaskularisationsmembranen (CNV) spielt, besteht bei einer Uveitis posterior das Risiko einer CNV-Bildung. Erkrankungen wie das Presumed ocular Histoplasmosis Syndrom (POHS), die multifokale Choroiditis (MFC) oder die Punctate inner Choroidopathy (PIC) tragen dabei ein sehr hohes CNV-Risiko. Meistens werden durch inflammatorische Prozesse klassische Membranen ausgelöst. Dieses hat neben der häufig kleinen CNV-Größe und dem jüngeren Alter der Patienten den Vorteil der besseren Behandelbarkeit. Analog der CNV-Membranen bei der AMD wurden inflammatorische Membranen vor der Anti-VEGF-Ära mittels Argonlaserkoagulation und später dann mittels PDT behandelt. Deutlich bessere Visusergebnisse lassen sich heutzutage mit VEGF-Inhibitoren, gegebenenfalls in Verbindung mit einer PDT erreichen. Wenige Publikationen mit größeren Patientenzahlen aufgrund der Seltenheit des Erkrankungsbilds sowie zahlreiche Falldarstellungen können dieses belegen. Neben der symptomatischen Behandlung der CNV-Membran sollte bei diesen Erkrankungsbildern jedoch nie die Entzündungskontrolle vergessen werden, da sie den Trigger darstellt.

Abstract

Inflammation plays a key role in the induction of choroidal neovascular membranes (CNV). This explains why each form of posterior uveitis may lead to CNV formation. Diseases like presumed ocular histoplasmosis syndrome (POHS), multifocal choroiditis (MFC) or punctate inner choroidopathy (PIC) carry a high risk of CNV creation. Inflammatory processes mostly cause classical membranes. Because of the classical membrane form, smaller membrane size and the younger age of the patientsʼ inflammatory membranes are often better treatable than membranes in AMD patients. In the times before VEGF inhibition inflammatory membranes were treated with argon laser coagulation and later with PDT. Nowadays better visual acuity results are achievable through VEGF inhibitor injections with or without PDT. This is proven by a few publications with greater numbers of patients because of the rarity of the diseases and several case reports in the literature. In addition to CNV treatment the control of intraocular inflammation should never be forgotten because it forms the leading CNV trigger.

Schlüsselwörter

Chorioidea - Retina - intraokulare Entzündungen - Infektiologie

Key words

choroid - retina - intraocular inflammation - infectious diseases

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