Morphologische Kriterien in der hochauflösenden optischen Kohärenztomografie (SD-OCT) als prognostischer Faktor der Behandlung des Makulaödems bei retinalen venösen Verschlüssen

 

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Zusammenfassung

Hintergrund: Das SD-OCT stellt eine wesentliche Säule der Diagnostik zur Beurteilung des Makulaödems bei retinalen venösen Verschlüssen (RVV) dar. Anhand des hochauflösenden Schnittbilds können zahlreiche morphologische Unterschiede und Merkmale herausgelesen werden. Ziel dieser Studie ist die Untersuchung des Zusammenhangs zwischen morphologischen Kriterien und der Visusprognose bei intravitrealer operativer Medikamenteneingabe (IVOM). Material und Methoden: 81 Patienten mit Makulaödem aufgrund von Venenast- bzw. Zentralvenenverschlüssen (VAV: n = 38/ZVV: n = 43) und Z. n. IVOM (Dexamethason: n = 53/Ranibizumab: n = 28) wurden retrospektiv erfasst. Es wurden die präoperativen SD-OCT-Bilder bez. der Kriterien Glaskörperanheftung, epiretinaler Membran, fovealer Kontur, Höhe intraretinaler zystoider Veränderungen (ZV), Integrität der Netzhautaußenschichten sowie subretinaler Veränderung untersucht. Der Einfluss der o. g. Kriterien auf den Visusanstieg bei einer intravitrealen Wiederbehandlung wurde analysiert. Ergebnis: Es zeigte sich eine starke Streuung der Daten im Hinblick auf nahezu alle untersuchten Merkmale. Patienten wiesen unabhängig von ihrer Therapie einen mittleren Visusanstieg von 9,51 ETDRS-Buchstaben (ETDRS: Early Treatment of Diabetic Retinopathy Study) auf: Dexamethason: 9,62/Ranibizumab: 9,29). Patienten mit feinen intraretinalen ZV (≤ 250 µm) wiesen mit 19,44 ETDRS-Buchstaben, gegenüber 7,23 ETDRS-Buchstaben bei Patienten mit konfluierenden ZV einen signifikant größeren Visusanstieg auf (p = 0,009). Zudem konnte beobachtet werden, dass Patienten mit einem kuppelförmigen Ödem eine signifikant größere Ödemreduktion aufwiesen als Patienten mit verstrichener fovealer Kontur (p = 0,004). Schlussfolgerung: In der Beurteilung des OCTs stehen für den Betrachter bisher der Nachweis sowie die Höhe des Ödems im Vordergrund. Im Hinblick auf einen möglichen Therapieerfolg und Visusanstieg scheint allerdings die Größe und Art der ZV ein weiteres bedeutendes Beurteilungskriterium darzustellen.

Abstract

Background: SD-OCT is an important tool in the diagnosis of macular oedema (ME) due to retinal vein occlusion (RVO). Its high resolution makes it possible to distinguish various morphological characteristics and differences. The aim of this study is to evaluate the correlation between morphological patterns and the development of visual acuity (VA) after intravitreal treatment of ME due to RVO. Methods: 81 patients on intravitreal treatment (dexamethasone: n = 53/ranibizumab: n = 28) due to ME associated with branch and central retinal vein occlusion (BRVO: n = 38/CRVO: n = 43) were retrospectively reviewed. Preoperative SD-OCT images were analysed by vitreous adhesion, epiretinal membranes, foveal contour, height of intraretinal cystoid spaces, inner and outer segment integrity and presence of subretinal fluid. The influence of these patterns on VA improvement was analysed. Results: In almost every morphological pattern, the data were highly variable. Therapy was effective, with a medium gain in VA of 9.51 letters ETDRS (dexamethasone: 9.62 letters/ranibizumab: 9.29 letters). The improvement in VA in patients with small intraretinal cystoid spaces (thickness ≤ 250 µm) was 19.44 letters ETDRS, compared to 7.23 letters ETDRS in patients with confluent cystoid spaces (p = 0.009). Patients with a convex fovea exhibited more pronounced reduction in central retinal thickness (CRT) (p = 0.004). Conclusion: Analysis of OCT has concentrated on demonstrating oedema and CRT. Our data indicate that detailed OCT morphology and the size of intraretinal cystoid spaces offer important information about VA prognosis after intravitreal therapy in ME due to RVO.

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