Isolierter Verschluss einer zilioretinalen Arteriole – Klinik und Verlauf in 31 Fällen

Zusammenfassung

Hintergrund: Untersuchung des Krankheitsverlaufs dieses seltenen Typs eines retinalen Arteriolenverschlusses in einem großen Patientenkollektiv.

Patienten und Methoden: Die Krankenblattunterlagen aller Patienten, die an der Augenklinik der Universitätsmedizin Mainz (Germany) im Zeitraum 1/1998 bis 12/2009 angiografisch mit isoliertem zilioretinalem Arteriolenverschluss (ZRAV) diagnostiziert wurden, wurden retrospektiv ausgewertet. Standardtherapie war eine intravenöse Antikoagulation mit Heparin. Mediane Nachbeobachtungszeit 51 Monate.

Ergebnisse: In die Studie eingeschlossen wurden 31 Augen von 31 Patienten (Altersmedian 49 Jahre, Range 25 − 71 Jahre). Signifikante Karotidsklerose in 17/31 Fällen. Alle Verschlüsse waren am temporalen Papillenrand lokalisiert und wiesen Makulabeteiligung auf (2 × Choesterolemboli). Angiografisch zeigte kein Auge einen kompletten Verschluss, alle Augen eine späte retrograde Füllung und 10/31 Augen zusätzliche Störungen der Aderhautperfusion. Der Gesichtsfelddefekt (zentrozaekal in 25/31 Augen) verkleinerte sich zwar in der Nachbeobachtungsphase, blieb allerdings in allen 25 Augen persistierend nachweisbar. Die optische Kohärenztomografie (durchgeführt in 10/31 Augen) zeigte im Infarktareal während des akuten Geschehens ein intraretinales Ödem und Monate später eine Verminderung der Netzhautdicke, entsprechend einer Atrophie der neurosensorischen Netzhaut. Im Krankheitsverlauf erreichten 23/31 Augen wieder Lesesehschärfe (0,4 oder besser), jedoch nur 2 von 10 Augen mit assoziierten Störungen der Aderhautperfusion.

Schlussfolgerung: Die Sehschärfenprognose von isolierten ZRAV scheint besser als bei anderen retinalen Arteriolenverschlüssen, sofern nicht die komplette Foveaarkade betroffen ist und angiografisch keine Aderhautbeteiligung vorliegt.

Abstract

Purpose: The aim of this study was to evaluate the outcome of this rare type of retinal vascular occlusion in a large patient series.

Patients and Methods: A retrospective chart review of all patients with an isolated cilioretinal artery obstruction seen at the University Eye Clinic Mainz (Germany) between 1/1998 and 12/2009 was performed. Standard treatment was intravenous anticoagulation with heparin. Follow-up mean was 51 months.

Results: Included in this study were 31 eyes from 31 patients (mean patient age 49 years, range 25 – 71 years). Significant atherosclerotic carotid artery obstruction in 17/31 cases. All occlusions were located temporally and involved some portion of the fovea (2 × cholesterol emboli). Fluorescein angiography revealed no eye with complete occlusion of the cilioretinal artery, but late retrograde filling in all eyes and associated choroidal filling defects in 10/31 eyes. During follow-up the scotomatous visual field defect (centrocaecal in 25/31 eyes) usually reduced in size, but scotoma was a persisting remnant of this episode in all eyes. Optical coherence tomography during the acute injury revealed intraretinal oedema in the area of the infarct and months afterwards an attenuated retinal thickness, consistent with retinal atrophy. Visual outcome achieved 20/50 (reading vision) in 23/31 eyes, but in only 2 of 10 eyes with associatted choroidal perfusion defects.

Conclusions: The visual prognosis of isolated cilioretinal artery obstructions seems to be significantly better than for other types of retinal artery occlusion, unless the entire perifoveal capillary network is affected and choroidal involvement is shown angiographically.

Schlüsselwörter

zilioretinale Arteriole - retinaler Arterienverschluss - zilioretinaler Arterienverschluss - Atherosklerose der Karotiden

Key words

cilioretinal artery - retinal artery occlusion - cilioretinal artery occlusion - atherosclerotic carotid artery

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