Augenbeteiligung bei Sarkoidose

 

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Zusammenfassung

Bei der Sarkoidose handelt es sich um eine entzündliche Multisystemerkrankung ungeklärter Pathogenese. Wegweisendes Merkmal ist die Bildung von nicht nekrotisierenden epitheloidzelligen Granulomen. Obschon der häufigste Manifestationsort die Lunge ist, können alle Organsysteme betroffen sein. Eine Augenbeteiligung findet sich in 25–50 % der Patienten. Häufigste Manifestation am Auge ist die Uveitis, welche vorwiegend anterior lokalisiert ist. Die Verdachtsdiagnose einer okulären Sarkoidose erfordert eine interdisziplinäre Diagnostik mittels Laboruntersuchungen, Röntgenaufnahme der Lunge und internistischer Mitbeurteilung sowie ggf. mit histopathologischem Nachweis der Granulombildung aus betroffenen Arealen. Differenzialdiagnostisch müssen infektiöse granulomatöse Systemerkrankungen ausgeschlossen werden, insbesondere eine Tuberkulose und Lues. Im Rahmen der ophthalmologischen Diagnostik kommt dem Nachweis granulomatöser Läsionen ein besonderer Stellenwert zu, insbesondere der Fluoreszenz- und Indocyaningrünangiografie zum Nachweis chorioretinaler Läsionen. Die häufigsten visuslimitierenden Komplikationen sind das zystoide Makulaödem und das Sekundärglaukom. Lokal und/oder systemisch gegebene Kortikosteroide stellen die Therapie der ersten Wahl dar. Abhängig vom Entzündungsverlauf und der Entwicklung von visuslimitierenden Komplikationen muss ggf. eine steroidsparende immunsuppressive Basistherapie eingeleitet werden.

Abstract

Sarcoidosis is an inflammatory multi-organ disease of unknown pathogenesis, characterised by non-necrotising granulomata. Sarcoidosis predominantly manifests in the lung, but any other organ may be affected. Ocular involvement is present in about 25 to 50 % of patients. The most common ocular manifestation is uveitis, especially of the anterior eye segment. If ocular sarcoidosis is suspected, interdisciplinary assessment of the patient is mandatory, including laboratory tests, chest X-ray, assessment by a specialist in internal medicine and, ideally, histological evidence of granuloma formation in a tissue specimen. Other (infectious) causes of granulomatous inflammation need to be excluded, especially tuberculosis or syphilis. For the ophthalmological assessment, detection of granulomatous lesions is of particular importance, especially by visualising chorioretinal granuloma by fluorescein and indocyanin green angiography. Cystoid macular oedema and glaucoma are the most frequent complications limiting visual acuity. Corticosteroids, which can be administered either locally or systemically, are the mainstay of therapy. Depending on the clinical course and the development of ocular complications, systemic steroid-sparing immunosuppressive medication may be indicated.

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