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Klin Monbl Augenheilkd 2016; 233(03): 257-265
DOI: 10.1055/s-0042-101554
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Drusenpapille – ein Überblick über medizinhistorische und aktuelle Aspekte

Optic Disk Drusen: Historical and Up-To-Date Aspects
M. M. Nentwich
1   Augenklinik und Poliklinik, Augenklinik der Julius-Maximilians Universität Würzburg
,
J. Maertz
2   Universitäts-Augenklinik, Ludwig-Maximilians-Universität München
,
G. Rudolph
2   Universitäts-Augenklinik, Ludwig-Maximilians-Universität München
› Author Affiliations
Further Information

Publication History

eingereicht 23 November 2015

akzeptiert 20 January 2016

Publication Date:
24 March 2016 (online)

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Zusammenfassung

Die Drusenpapille ist eine wichtige Differenzialdiagnose bei der Abklärung eines prominenten Sehnervenkopfs. Drusen der Papille kommen Studien zufolge bei 0,34–2,4 % der Menschen vor und sind in 3 von 4 Fällen bilateral. In histologischen Untersuchungen werden Drusen der Papille im Vergleich zu einer rein auf der Ophthalmoskopie beruhenden Diagnosestellung etwa 6-mal häufiger gefunden. Ein familiär gehäuftes Auftreten bei ansonsten unauffälligen Patienten sowie Assoziationen mit Retinitis pigmentosa, Joubert-, oder Alagille-Syndrom sind beschrieben. In der klinischen Praxis stehen mit der Fundusautofluoreszenz, der optischen Kohärenztomografie (OCT) und vor allem dem Ultraschall nicht invasive diagnostische Verfahren zur Verfügung. Drusen der Papille sind zumeist asymptomatisch. Durch vorübergehende Durchblutungsstörungen kann es zu einer transienten Visusverschlechterung kommen. Insbesondere oberflächliche Drusen der Papille können jedoch im Erwachsenenalter zu teils ausgedehnten Gesichtsfelddefekten führen. Um mögliche Gesichtsfelddefekte infolge von Drusen der Papille frühzeitig entdecken zu können, werden regelmäßige klinische Untersuchungen mit Tonometrie und Gesichtsfelduntersuchung empfohlen. Die radiäre Optikusneurotomie (RON) scheint bei jenen Patienten eine therapeutische Option darzustellen, bei denen es kürzlich zu einem raschen Gesichtsfeldverfall gekommen ist.

Abstract

Optic disc drusen are an important differential diagnosis in the diagnostic evaluation of a prominent optic nerve head. Drusen of the optic disc occur in 0.34 to 2.4 % of human individuals and manifest themselves bilaterally in three of four cases. Drusen are found six times more often within histological sections than on funduscopic examination. It is known that optic disc drusen can occur in familial clusters without any other pathological ophthalmic findings. They can also be associated with retinitis pigmentosa, or with the Joubert or Alagille syndromes. Non-invasive diagnostic tools include fundus-autofluorescence (AF), optical coherence tomography (OCT) and ultrasound. Drusen of the optic nerve head are asymptomatic in most cases, though transient ischemia can lead to transient visual impairment. In particular, superficial drusen can lead to profound visual field defects in adulthood. Regular ophthalmological follow-up examinations with tonometry and perimetry are recommended for the early detection of visual field defects. Radial optic neurotomy (RON) seems to be a therapeutic option in patients with acute deterioration of the visual field.

Schlüsselwörter

Genetik - Bildgebung - Papillenanomalie - Drusenpapille

Key words

genetics - imaging - optic disc anomaly - optic disc drusen
 

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