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Klin Monbl Augenheilkd 2012; 229(4): 306-313
DOI: 10.1055/s-0031-1299394
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Classification of Choroiditis Based on Inflammatory Lesion Process rather than Fundus Appearance: Enhanced Comprehension through the ICGA Concepts of the Iceberg and Jellyfish Effects

Klassifikation der Aderhautentzündungen (Choroiditiden) aufgrund des Entzündungsprozesses basierend auf Indozyanin-Grün-angiografischen Konzepten
C. P. Herbort
1   Inflammatory and Retinal Eye Diseases, Centre for Ophthalmic Specialised Care, Lausanne, Switzerland
2   University of Lausanne, Lausanne, Switzerland
,
M. Papadia
1   Inflammatory and Retinal Eye Diseases, Centre for Ophthalmic Specialised Care, Lausanne, Switzerland
3   Eye Clinic, Department of Neurosciences, Ophthalmology and Genetics, University of Genova, Genova, Italy
,
A. Mantovani
4   Department of Ophthalmology, Ospedale Valduce, Como, Italy
› Author Affiliations
Further Information

Publication History

16 September 2011

02 November 2011

Publication Date:
11 April 2012 (online)

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Abstract

Choroidal inflammatory diseases have been classically grouped under the term of white dot syndromes (WDS), a term only based on the appearance (white-yellow dots) of inflammatory fundus lesions. This purely descriptive and vague terminology, regrouping a pot-pourri of posterior inflammatory conditions, probably came into use because the precise exploration of the choroid was not possible, and also because many of the diseases were rare and not well understood. Since the availability of indocyanine green angiography (ICGA) that allows one to explore the choroidal compartment, it became possible to understand the lesion mechanism of choroiditides and to classify this group of diseases according to their pathophysiological behaviour. It was our aim to show here that the term WDS is applied to and encompasses inflammatory conditions that are characterized by completely different lesion mechanisms and should therefore be classified separately from each other. ICGA made it possible to differentiate two types of choroiditides, including on the one hand inflammatory diseases of the choroidal stroma and on the other hand inflammatory diseases of the choriocapillaris. Unfortunately, twenty years after its advent, ICGA is still not used routinely in uveitis centres and the traditional inappropriate but overall useless term of WDS is still used, maintaining the confusion about these diseases. The aim of this work was (i) to illustrate that meaningful exploration of choroidal inflammation, mostly occult and inaccessible to usual investigations, has to be performed using ICGA, (ii) to insist on the crucial importance of ICGA in the management of choroiditis and (iii) to enhance the comprehension of the ICGA-based classification of choroiditis, by using the demonstrative and striking analogue concepts of iceberg and jellyfish effects.

Zusammenfassung

Entzündliche Aderhauterkrankungen (Choroiditiden) werden traditionell unter dem Begriff „White dot syndromes“ (WDS) zusammengefasst. Diese Terminologie basiert einzig und allein auf dem Fundusaspekt (weiße Fundus-Flecken) der Läsionen und versammelt Krankheitsbilder, die nichts miteinander zu tun haben. Durch die Indozyanin-Grün-Angiografie (ICGA) kann heutzutage die Aderhaut präzise untersucht werden. Dies erlaubt, die Pathogenese der Choroiditiden zu verstehen und macht es möglich, diese Krankheiten nach deren Mechanismus neu einzuteilen. Unser Ziel war es, zu zeigen, dass die Terminologie „WDS“ wenig Sinn macht und nichts als Konfusion erzeugt, da sie Krankheiten mit diverser Pathogenese in einen Topf wirft. Besser ist es, diese Krankheiten nach den 2 wichtigsten pathophysiologischen Mechanismen einzuteilen: nämlich 1. entzündliche Krankheiten des choroidalen Stromas und 2. Choriocapillaris-Entzündungen. Obwohl ICGA seit fast 20 Jahren praktiziert wird, ist die Methode leider noch nicht weit und breit in allen Uveitis-Zentren angenommen worden. Deswegen wollten wir in dieser Übersichtsarbeit durch anschauliche Konzepte wie „Eisberg oder Quallen Effekt“ den Kliniker auf die Wichtigkeit der ICGA-Abklärung aufmerksam machen, ohne die eine umsichtige Behandlung des Uveitispatienten mit Aderhautentzündung nicht denkbar ist.

Key words

choroiditis - indocyanine green angiography (ICGA) - stromal choroiditis - choriocapillaritis - iceberg effect - jellyfish effect - white dot syndromes

Schlüsselwörter

Choroiditis - Indozyanin-Grün-Angiografie (ICGA) - stromale Choroiditis - Choriocapillaritis - Eisbergkonzept - Quallenkonzept - Weiße Flecken Syndrome
 

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