Arterielle okuläre Gefäßverschlüsse bei systemischer venöser Thrombophilie - 2 Kasuistiken

Zusammenfassung

Hintergrund: Arterielle okuläre Gefäßverschlüsse bei gesunden, jungen Männern sind ungewöhnlich. Über das Ausmaß der adäquaten Thrombophilie-Diagnostik herrscht angesichts der vielfach widersprüchlichen Studienergebnisse erhebliche Verunsicherung. Wir berichten über den Verlauf der Thrombophilie-Diagnostik bei zwei jungen Patienten mit nichtarteriitischer anteriorer ischämischer Optikusneuropathie (NAION) bzw. Arterienastverschluss (AAV). Kasuistik: Wir berichten über zwei junge, bis dahin gesunde Männer. Wegen der festgestellten Perfusionsstörung im arteriellen Gefäßbett hatte eine erste Therapie-Empfehlung bei beiden in thrombozytenaggregationshemmenden Wirkstoffen bestanden. Die Suche nach Emboliequellen im arteriellen Stromgebiet ergab bei beiden ein signifikantes kardiales bzw. intrapulmonales venösarterielles Shuntvolumen. Das daraufhin in die Wege geleitete Thrombophilie-Screening nach Risikofaktoren für Verschlüsse des venösen Gefäßbettes ergab bei beiden eine homozygote bzw. heterozygote Faktor-V-Leiden-Mutation sowie eine Hyperhomocysteinämie. Schlussfolgerungen: Beide Fälle zeigen, dass bei Auftreten arterieller okulärer Gefäßkomplikationen die Suche nach Shuntvolumina unerlässlich ist und gegebenenfalls zusätzlich zu den typischen Risikofaktoren für arterielle Gefäßverschlüsse ein Screening nach venösen Thrombophilie-Faktoren angeschlossen werden muss.

Abstract

Background: Arterial ocular occlusions in apparently healthy young men are unusual. Because of inconsistent study results there is a great amount of insecurity with respect to the reasonable diagnostic approach in such a scenario. We report on the process of diagnostic steps in two young men with arterial ocular occlusion such as non-arteritic optic neuropathy (NAION) and branch retinal arterial occlusion (BRAO). Case Report: Here, we report on two hitherto healthy young men who suffered from ocular arterial occlusions. Because of the apparent arterial perfusion deficit at first thrombocyte aggregation-inhibiting substances were recommended. On searching for the underlying embolic source in both men a significant arterial-venous cardiac and pulmonary shunt volume was identified. Additional screening for risk factors for venous thrombosis resulted in the identification of Factor V Leiden as well as hyperhomocysteinemia. Conclusion: These two cases stress the importance to exclude possible arterial-venous shunts and, if identified, the need to search for additional risk factors for venous thrombosis in patients with arterial embolic ocular disease.

Schlüsselwörter

okuläre Gefäßverschlüsse - gekreuzte Embolie - arteriovenöser Shunt - Thrombophilie

Key words

vascular ocular occlusion - paradoxical embolism - arterial-venous shunt - thrombophilia

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