- •Vorwort zur 3. Auflage
- •Inhaltsverzeichnis
- •Abkürzungsverzeichnis
- •Autorenverzeichnis
- •1 Epidemiologie der AMD
- •1.1 Klassifikation
- •1.2 Häufigkeit
- •1.2.1 Prävalenz
- •1.2.2 Inzidenz
- •1.3 Natürlicher Verlauf
- •1.4 Genetische Faktoren
- •1.4.1 Gene des Komplementsystems
- •1.4.2 ARMS2-Lokus (10q26)
- •1.4.3 Gene des Lipidmetabolismus
- •1.5 Umweltfaktoren
- •1.5.1 Rauchen
- •1.5.2 Antioxidanzien
- •1.5.3 Body-Mass-Index
- •1.5.4 Hypertonie
- •1.5.5 Kataraktchirurgie
- •1.6 Interaktion zwischen Risikofaktoren
- •Literatur
- •2 Genetik
- •2.1 Einleitung
- •2.3 Frühe Erkenntnisse
- •2.3.1 ABCA4-Gen
- •2.4.1 Funktionelle Implikationen
- •Literatur
- •3 Alterung der Netzhaut und des retinalen Pigmentepithels*
- •3.1 Einleitung
- •3.2 Ursache und Folgen des Alterns
- •3.4 Alterung der Neuroretina
- •3.5.3 Akkumulation von Lipofuszin
- •Literatur
- •4 Das Komplementsystem bei der AMD
- •4.1 Einleitung
- •4.2 Das Komplementsystem
- •4.6 Schlussfolgerung
- •Literatur
- •5 Histopathologie
- •5.1 Retinales Pigmentepithel
- •5.2 Bruch-Membran
- •5.2.1 Aufbau der Bruch-Membran
- •5.3 Chorioidale Neovaskularisation
- •Literatur
- •6.1 Einleitung
- •6.2 Drusen
- •6.4 Störungen der Aderhautperfusion
- •Literatur
- •7 Klinische Manifestationen der choroidalen Neovaskularisation bei AMD
- •7.1 Einleitung
- •7.2.1 Minderung der Sehschärfe
- •7.2.2 Metamorphopsie
- •7.2.3 Gesichtsfeldausfälle
- •7.2.4 Weitere Symptome
- •7.3.1 Blutung
- •7.3.4 Weitere Befunde
- •7.4.1 Fluoreszein-Angiographie
- •7.4.2 Indozyaningrün-Angiographie
- •7.4.3 Autofluoreszenz
- •7.4.4 Optische Kohärenztomographie
- •Literatur
- •8 Geographische Atrophie
- •8.1 Einführung
- •8.2 Klinische Merkmale
- •8.3 Histologie und Pathogenese
- •8.7 Risikofaktoren
- •8.7.1 Genetische Faktoren
- •8.7.2 Systemische Risikofaktoren
- •8.7.3 Okuläre Risikofaktoren
- •8.9.1 Messung der Sehschärfe
- •8.9.2 Kontrastsensitivität
- •8.9.3 Lesegeschwindigkeit
- •8.9.4 Fundusperimetrie
- •8.10 Therapeutische Ansätze
- •8.10.2 Antiinflammtorische Substanzen
- •8.10.3 Komplementinhibition
- •8.10.4 Neuroprotektion
- •8.10.6 Serotonin-1A-Agonist
- •Literatur
- •9 Imaging bei AMD
- •9.1 Einleitung
- •9.2 Farbphotographie
- •9.3 Monochrome Photographie
- •9.4 Autofluoreszenz
- •9.5 Optische Kohärenztomographie
- •9.5.1 Welleneigenschaften des Lichts
- •9.5.2 Kohärenzlänge
- •9.6 Angiographie
- •9.6.5 Fluoreszein-Injektion
- •9.6.6 Fluoreszein-Angiographie
- •9.6.7 Indozyaningrün-Angiographie
- •9.7.1 Drusen
- •9.8 Neovaskuläre AMD
- •9.10 Follow-up
- •9.10.1 Thermischer Laserkoagulation
- •9.10.2 Photodynamische Therapie
- •9.11 Anti-VEGF-Therapie
- •Literatur
- •10 Optische Kohärenztomographie
- •10.1 Einleitung
- •10.4 OCT bei geographischer Atrophie
- •10.5 OCT bei exsudativer AMD
- •Literatur
- •11 Mikroperimetrie
- •11.1 Einleitung
- •11.2 Technische Entwicklung
- •11.2.2 Automatische Mikroperimetrie
- •11.2.4 Mikroperimetrie: Auswertung
- •11.2.5 Weitere Mikroperimeter
- •11.3 Mikroperimetrie bei AMD
- •11.3.2 Geographische Atrophie
- •11.3.3 Neovaskuläre AMD
- •11.3.4 Therapie der neovaskulären AMD
- •Literatur
- •12 Nahrungsergänzung
- •12.1 Einleitung
- •12.2 Antioxidanzien und Zink
- •12.3 β-Carotin
- •12.4 Makuläre Xantophylle
- •12.6 Vitamin E
- •12.7 Vitamin C
- •12.8 Zink
- •12.10 AREDS2
- •Literatur
- •13.1 Einleitung
- •13.2 Grundlagen
- •13.2.1 Klinischer Hintergrund
- •13.2.2 Laserphotokoagulation
- •13.2.3 Photodynamische Therapie
- •13.3 Behandlungsabläufe
- •13.3.1 Laserphotokoagulation
- •13.3.2 Photodynamische Therapie
- •13.4 Studienergebnisse
- •13.4.1 Laserphotokoagulation
- •13.4.2 Photodynamische Therapie
- •13.5.1 Laserphotokoagulation
- •13.5.2 Photodynamische Therapie
- •13.6 Varianten
- •13.6.2 Photodynamische Therapie
- •13.7 Derzeitige Leitlinien
- •13.7.1 Laserphotokoagulation
- •13.7.2 Photodynamische Therapie
- •13.8 Perspektiven
- •14 Anti-VEGF-Therapie: Grundlagen und Substanzen
- •14.1 Einleitung
- •14.2 Vascular endothelial growth factor
- •14.3.1 Sequestrierung von freiem VEGF
- •14.4 Neue Applikationsformen
- •14.5 Kombinationstherapie
- •Literatur
- •15.1 Hintergrund
- •Literatur
- •16 Kombinationstherapien zur Behandlung der AMD
- •16.1 Einleitung
- •Literatur
- •17 Behandlungsansätze bei trockener AMD
- •17.1 Einleitung
- •17.2 Aktuelle Behandlungsmöglichkeiten
- •17.3 Die Ursachen der AMD adressieren
- •17.4.1 Endpunkte klinischer Studien
- •17.4.3 Modulatoren des Sehzyklus
- •17.5 Zusammenfassung
- •Literatur
- •18 Chirurgische Therapie
- •18.1 Makulaplastik
- •18.2 Makulatranslokation
- •18.5 Indikationen zur Chirurgie
- •18.5.1 Non-Responder
- •18.5.2 Pigmentepithelruptur
- •18.5.3 Massive submakuläre Blutung
- •18.5.4 Trockene AMD
- •Literatur
- •19 Lesefähigkeit bei AMD
- •19.1 Einleitung
- •19.2 Physiologische Grundlagen
- •19.3.3 Beurteilung des Fixationsverhaltens
- •19.3.4 Motorik
- •Literatur
- •20 Vergrößernde Sehhilfen bei AMD
- •20.4 Vergrößerungsmöglichkeiten
- •20.8 Elektronische Vorlesegeräte
- •20.9 Ergänzende Hilfsmittel
- •20.11 Grundlagen der Verordnung
- •Literatur
- •Stichwortverzeichnis
Literatur |
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Abb. 3.9 Fundusautofluoreszenz-Bilder. |
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Vergleich der gesamten Fundusfluores- |
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zenz zwischen einem jungen (a) und |
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einem alten Patienten (b), der wenig hö- |
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here Werte bei der älteren Person ergibt. |
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c Aufnahme von 2005 mit dem Heidelberg |
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HRA-II-Scanning-Laserophthalmoskop. Bei |
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dem 74-jährigen Patienten mit einer Seh- |
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schärfe von 20/40 zeigten sich mehrere |
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Gebiete mit RPE-Atrophie sowie wenige |
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kleine Areale erhöhter Autofluoreszenz an |
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den Grenzen der größeren Läsionen. Zu |
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diesem Zeitpunkt war die Autofluoreszenz |
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der Fovea normal und es wurde dem Pati- |
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enten mitgeteilt, dass eine Progression be- |
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vorstand. d Zwei Jahre später wurde der |
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Patient erneut untersucht. Die Sehschärfe |
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hatte sich auf 20/200 verringert und die |
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mit dem gleichen Gerät aufgenommene |
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Autofluoreszenz zeigte eine ausgedehnte |
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geographische Atrophie, die auch die |
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Fovea einschloss. (Bilder und Bildtext mit |
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freundlicher Genehmigung von Dr. Erik |
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c |
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Van Kuijk, Ophthalmology and Visual Sci- |
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ences, UTMB, Galveston, Texas) |
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bei betagten, jedoch nicht bei jungen Tieren verursachen kann [159, 160].
Fazit
▬Altersabhängige Veränderungen in der Neuroretina und dem RPE gehen mit einer zunehmenden Anfälligkeit einher, eine AMD zu entwickeln.
▬Zu den altersabhängigen Veränderungen gehören der Verlust des Fundusreflexes, stärkere Sichtbarkeit großer choroidaler Gefäße, Gebiete mit Hypound Hyperpigmentierung, eine merkliche Zunahme der Fundusautofluoreszenz und das Erscheinen fokaler Sub-RPE-Ablagerun- gen, sog. Drusen.
▬Die retinale Alterung ist ein multifaktorieller Prozess, der sowohl umweltbedingte Schäden als auch genetische Prädisposition mit einschließt.
▬Unter den altersabhängigen Veränderungen auf zellulärer Ebene haben der Verlust an mitochondrialer Funktion, erhöhte ROS-Produktion, Anhäufung oxidativer Schäden, Akkumulation von Lipofuszin, eine veränderte Immunantwort und Veränderungen der Bruch-Membran eine Schlüsselfunktion inne.
▬Oxidative Schäden spielen offenbar eine zentrale Rolle bei der retinalen Alterung und können möglicherweise durch den Einsatz systemischer Antioxidanzien günstig beeinflusst werden.
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