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Biomarker in der Therapie venöser retinaler Gefäßverschlüsse

Biomarkers in the treatment of retinal vein occlusion

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Zusammenfassung

Hintergrund

Retinale Venenverschlüsse, subsumiert in Zentralvenen- und Venenastverschluss, gehören zu den häufigsten vaskulären Erkrankungen der Netzhaut. Sowohl bei Erstdiagnose als auch in der Therapie verschlussassoziierter Komplikationen, v. a. des Makulaödems, sind Biomarker der optischen Kohärenztomographie (OCT), OCT-Angiographie und (Ultraweitwinkel‑)Fluoreszeinangiographie von herausragender Bedeutung.

Methoden

Es erfolgte eine systematische Literaturrecherche auf pubmed.gov mit den Keywords „central retinal vein occlusion“, „branch retinal vein occlusion“, „biomarker“, „OCT“, „OCT angiography“, „ultra-widefield fluorescein angiography“ mit Priorisierung der wichtigsten Aspekte zur Umfangsreduktion.

Ergebnisse

Als relevante Biomarker konnten in der OCT Makuladicke („central retinal thickness“ [CRT]), makuläre Flüssigkeit, die Integrität der Photorezeptorbande (Membrana limitans externa [ELM] und „ellipsoid zone“ [EZ]), „disorganization of retinal inner layers“ (DRIL), hyperreflektive Foci, Aderhautdicke sowie Ischämiezeichen wie „prominent middle limiting membrane“ (p-MLM), die „paracentral acute middle maculopathy“ (PAMM) sowie „hyperreflectivity of inner retinal layers“ (HIRL) identifiziert werden. Der Stellenwert der OCT-Angiographie liegt v. a. in der Beurteilung mikrovaskulärer Veränderungen, insbesondere der „vessel density“ im tiefen retinalen Gefäßplexus, der fovealen avaskulären Zone und von Arealen ohne Kapillarperfusion. Bezüglich der Therapieentscheidung zum Netzhautlaser sind Biomarker der Ultraweitwinkelangiographie wie periphere Ischämien („ischemic index“) sowie Neovaskularisationen essenziell.

Schlussfolgerung

Eine Vielzahl simplerer und komplexer Biomarker ermöglicht heute eine effektive individualisierte Therapie- und Prognoseeinschätzung beim retinalen Venenverschluss. Eine Verschiebung von invasiven zu nichtinvasiven Biomarkern wird beobachtet.

Abstract

Background

Retinal vein occlusion, subdivided into central retinal and branch retinal vein occlusion, is one of the most frequent vascular diseases of the retina. Biomarkers of optical coherence tomography (OCT), OCT-angiography and (ultra-widefield) fluorescein angiography are of exceptional importance in the initial diagnosis and also in the treatment of complications associated with retinal vascular occlusion, particularly macular edema.

Methods

A systematic literature review was carried out in PubMed with the keywords central retinal vein occlusion, branch retinal vein occlusion, biomarker, OCT, OCT angiography, ultra-widefield fluorescein angiography with prioritization of the most important aspects.

Results

Relevant biomarkers in OCT include central retinal thickness (CRT), macular fluid, the integrity of the photoreceptor bands (external limiting membrane and ellipsoid zone), disorganization of retinal inner layers (DRIL), hyperreflective foci, choroidal thickness and signs of ischemia, such as a prominent middle limiting membrane (p-MLM), paracentral acute middle maculopathy (PAMM) as well as hyperreflectivity of inner retinal layers (HIRL). The importance of OCT-angiography lies particularly in the assessment of microvascular alterations, especially vessel density in the deep retinal vascular plexus, the foveal avascular zone and of areas with no capillary perfusion. Biomarkers of ultra-widefield angiography, such as peripheral ischemia (ischemic index) and neovascularízation are essential with respect to treatment decisions for retinal laser.

Conclusion

A multitude of simple and complex biomarkers currently enable an effective individualized evaluation of treatment and prognosis in retinal vein occlusion. A shift from invasive to noninvasive biomarkers can be observed.

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Authors and Affiliations

  1. Augenklinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München, Mathildenstr. 8, 80336, München, Deutschland

    Jakob Siedlecki FEBO

  2. Augenklinik, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen, Deutschland

    Lars-Olof Hattenbach

  3. Augenklinik, Georg-August-Universität Göttingen Universitätsmedizin, Göttingen, Deutschland

    Nikolas Feltgen

  4. Augenklinik, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland

    Siegfried G. Priglinger MD

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Correspondence to Jakob Siedlecki FEBO.

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J. Siedlecki, L.-O. Hattenbach, N. Feltgen und S.G. Priglinger geben an: Keiner der Autoren hat finanzielle Interessen bezüglich dieser Studie anzumelden. J. Siedlecki hat zuvor Vortragshonorare und Reisekostenerstattungen von Novartis Pharma GmbH, Carl Zeiss Meditec AG, Oculentis OSD Medical GmbH, Allergan GmbH, Apellis Pharmaceuticals und Heidelberg Engineering GmbH erhalten. J. Siedlecki hat zuvor Beratergehälter von Bayer AG, Novartis Pharma GmbH, Allergan GmbH und Apellis Pharmaceuticals erhalten.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Siedlecki, J., Hattenbach, LO., Feltgen, N. et al. Biomarker in der Therapie venöser retinaler Gefäßverschlüsse. Ophthalmologie 119, 1111–1120 (2022). https://doi.org/10.1007/s00347-022-01732-1

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