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Thrombophiliediagnostik und Abklärung systemischer Risikofaktoren bei Patienten mit venösen retinalen Gefäßverschlüssen

Thrombophilic and systemic risk factors in patients with retinal vein occlusion

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Zusammenfassung

Für die Entstehung retinaler Gefäßverschlüsse kommt der Arteriosklerose eine entscheidende Rolle zu, sodass eine weiterführende kardiovaskuläre Abklärung unter Berücksichtigung von Alter und Risikofaktoren sinnvoll erscheint. Bei vielen Patienten mit venösen retinalen Gefäßverschlüssen lassen sich kardiovaskuläre Risikofaktoren jedoch nicht nachweisen. Nachdem die Bedeutung thrombophiler Gerinnungsstörungen für die Entstehung venöser retinaler Gefäßverschlüsse über viele Jahre kontrovers diskutiert worden war, konnten einige jüngere Studien einen Zusammenhang zwischen Gerinnungsstörungen und der Entstehung venöser retinaler Gefäßverschlüsse in bestimmten Subgruppen von Patienten eindeutig belegen. Folgende Kriterien weisen mit erhöhter Wahrscheinlichkeit auf eine zugrunde liegende thrombophile Gerinnungsstörung hin: ein junges Alter (≤45 Jahre) zum Zeitpunkt des Netzhautgefäßverschlusses oder eines vorangegangenen thromboembolischen Ereignisses, eine auffällige eigene oder Familienanamnese für Thromboembolien sowie das Fehlen kardiovaskulärer Risikofaktoren. Diese Indikatoren lassen die Durchführung eines selektiven Thrombophiliescreenings sinnvoll erscheinen.

Abstract

Over the past years there has been a dramatic increase in the number of identifiable causes of thrombophilia. However, as retinal vein occlusions (RVO) have a strong pathogenic correlation with the presence of hypertension or arteriosclerosis and the average age of affected patients is usually within the sixth or seventh decade of life, thrombophilia screening of RVO patients poses a particularly difficult diagnostic challenge. It is clear that to use medical resources appropriately and improve the level of interdisciplinary patient care in RVO, subgroup analysis is required. Just recently, some studies have demonstrated the significant role of coagulation disorders in specific subgroups of RVO patients and have provided recommendations for clinical practice. These results indicate that thrombophilic risk factors are significantly more prevalent among patients equal or less than 45 years of age at the time of RVO or a previous thromboembolic event, among patients with a remarkable family history of thromboembolism prior to the age of 45 years, or among patients without cardiovascular risk factors. According to these data, thrombophilia screening should be considered in these selected subgroups.

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Authors and Affiliations

  1. Klinik für Augenheilkunde, Universitätsklinikum Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    C. Kuhli-Hattenbach

  2. Medizinische Klinik III des Zentrums der Inneren Medizin, Abteilung für Hämostaseologie, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Deutschland

    W. Miesbach

  3. III. Medizinische Klinik, Abteilung für Hämostaseologie, Klinikum der Johannes-Gutenberg-Universität, Mainz, Deutschland

    I. Scharrer

  4. Klinik für Augenheilkunde, Klinikum Ludwigshafen am Rhein, Ludwigshafen, Deutschland

    L.-O. Hattenbach

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  1. C. Kuhli-Hattenbach
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  2. W. Miesbach
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  3. I. Scharrer
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  4. L.-O. Hattenbach
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Correspondence to C. Kuhli-Hattenbach.

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Kuhli-Hattenbach, C., Miesbach, W., Scharrer, I. et al. Thrombophiliediagnostik und Abklärung systemischer Risikofaktoren bei Patienten mit venösen retinalen Gefäßverschlüssen. Ophthalmologe 108, 104–110 (2011). https://doi.org/10.1007/s00347-010-2289-2

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