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Diagnostik und Differenzialdiagnostik bei akuter retinaler Nekrose

Diagnostics and differential diagnosis of acute retinal necrosis

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Zusammenfassung

Viren der Herpesfamilie sind für das Auftreten der akuten retinalen Nekrose (ARN) verantwortlich. Durch direkten Nachweis in Retinabiopsien, die Analyse intraokularer Antikörpersynthese und den molekularbiologischen Nachweis mittels PCR (Polymerasekettenreaktion) konnten Varizella-Zoster-, Herpes-simplex-Typ-1- und -2-Viren sowie Zytomegalieviren nachgewiesen werden. In die Differenzialdiagnose des ARN-Syndroms müssen die atypisch verlaufende Toxoplasmose, retinale Vaskulitiden und Erkrankungen der „White-Dot-Syndrome“ einbezogen werden. Da die Therapie dieser Erkrankungen erheblich differiert, ist eine rasche Abklärung entscheidend. Serologische Untersuchungen zum Nachweis der Virusinfektion bei V.a. ARN haben sich als wenig hilfreich erwiesen. Dagegen hat sich die Analyse von Kammerwasser- und Glaskörperproben bewährt. Die spezifische Antikörperanalyse und der Nachweis des Virusgenoms mittels PCR haben sich als exzellente diagnostische Hilfe mit hoher Sensitivität und Spezifität erwiesen. Mit diesem Beitrag sollen die diagnostischen Methoden sowie differenzialdiagnostischen Überlegungen der ARN dargestellt werden.

Abstract

Multiple viruses have been identified as causative agents in acute retinal necrosis (ARN). Retinal biopsies, analysis of intraocular antibody synthesis, and polymerase chain reaction (PCR) have identified varicella zoster virus, herpes simplex virus types 1 and 2, and cytomegalovirus. The differential diagnosis of ARN includes atypical ocular toxoplasmosis, some white dot syndromes, and other forms of retinal vasculitides such as Behçet’s disease. Because therapeutic intervention varies greatly in these acute situations, identification of the causative agent is essential. Serology is rarely helpful, whereas analysis of aqueous humor or vitreous samples provides clues to the etiology. Aqueous humor antibody testing and PCR have demonstrated excellent diagnostic power with high sensitivity and high specificity. This review is intended to provide an overview of the diagnostics and differential diagnosis of this rare but important disorder.

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Authors and Affiliations

  1. Universitäts-Augenklinik, Charité – Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland

    U. Pleyer & S. Metzner

  2. Institut für Medizinische Virologie, Helmut-Ruska-Haus, Charité, Universitätsmedizin Berlin, Berlin, Deutschland

    J. Hofmann

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  1. U. Pleyer
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Correspondence to U. Pleyer.

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Pleyer, U., Metzner, S. & Hofmann, J. Diagnostik und Differenzialdiagnostik bei akuter retinaler Nekrose. Ophthalmologe 106, 1074–1082 (2009). https://doi.org/10.1007/s00347-009-2049-3

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