Peripher exsudative hämorrhagische Chorioretinopathie: Krankheitsverlauf, Diagnosestellung inklusive Weitwinkelbildgebung der assoziierten Erkrankungen altersabhängige Makuladegeneration und polypoidale Choriovaskulopathie, Therapie

 

 Buy Article Permissions and Reprints

Zusammenfassung

Die PEHCR (peripher exsudative hämorrhagische Chorioretinopathie) ist eine Erkrankung, die sich klinisch besonders durch subretinale Blutungen, retinale Exsudate, retinale Pigmentepithelabhebungen (RPE-Abhebungen), exsudative Ablatio und Sub-RPE-Blutungen manifestiert. Die PEHCR-Läsion ist oft durch ihr polypoidales Muster charakterisiert, welches den Polypen der PCV (polypoidale Choriovaskulopathie) sehr ähnelt. Die Diagnosestellung erfolgt am besten mit einer Weitwinkel-ICGA (ICGA: Indocyaningrünangiografie). Bei ca. der Hälfte der Patienten werden am betroffenen Auge oder am Partnerauge makuläre Veränderungen in Form von Drusen bis hin zur exsudativen AMD (altersabhängigen Makuladegeneration) detektiert. Da es direkt zur PEHCR nur sehr wenig Literatur gibt, werden in dieser Arbeit zudem die im Rahmen der AMD beschriebenen peripheren Veränderungen, die mit Weitwinkelbildgebung untersucht wurden, diskutiert.

Abstract

PEHCR (peripheral exudative haemorrhagic chorioretinopathy) is a disease manifested clinically, particularly by subretinal bleeding, retinal exudates, retinal pigment epithelium detachments (RPE detachments), exudative retinal detachment and sub-RPE bleeding. The PEHCR lesion is often characterized by its polypoidal pattern, which is very similar to PCV (polypoidal choroidal vasculopathy) polyps. Diagnosis is best made with a wide-field ICGA (indocyanine green angiography). In approximately half of patients, macular changes in the form of drusen, up to exudative AMD (age-related macular degeneration), are detected in the affected eye or partner eye. Since there is very little literature directly available on PEHCR, this work also discusses the peripheral changes described in the context of AMD that were investigated with wide-field imaging.

• Literatur

• 1 Alforja MS, Sabater N, Giralt J. et al. Intravitreal bevacizumab injection for peripheral exudative hemorrhagic chorioretinopathy. Jpn J Ophthalmol 2011; 55: 425-427
  CrossrefPubMedGoogle Scholar
• 2 Angermann R, Haas G, Hofer M. et al. [Unclear uveal tumor with bleeding]. Ophthalmologe 2018; DOI: 10.1007/s00347-018-0650-z.
  PubMedGoogle Scholar
• 3 Annesley jr. WH. Peripheral exudative hemorrhagic chorioretinopathy. Trans Am Ophthalmol Soc 1980; 78: 321-364
  PubMedGoogle Scholar
• 4 Cebeci Z, Dere Y, Bayraktar Ş. et al. Clinical Features and Course of Patients with Peripheral Exudative Hemorrhagic Chorioretinopathy. Turk J Ophthalmol 2016; 46: 215-220
  PubMedGoogle Scholar
• 5 Heimann H, Kellner U. Atlas des Augenhintergrunds. Stuttgart: Thieme; 2010
  Google Scholar
• 6 Kim YT, Kang SW, Lee JH. et al. Peripheral exudative hemorrhagic chorioretinopathy in Korean patients. Jpn J Ophthalmol 2010; 54: 227-231
  CrossrefPubMedGoogle Scholar
• 7 Shields CL, Salazar PF, Mashayekhi A. et al. Peripheral Exudative Hemorrhagic Chorioretinopathy Simulating Choroidal Melanoma in 173 Eyes. Ophthalmology 2009; 116: 529-535
  CrossrefPubMedGoogle Scholar
• 8 Shields CL, Manalac J, Das C. et al. Choroidal melanoma: clinical features, classification, and top 10 pseudomelanomas. Curr Opin Ophthalmol 2014; 25: 177-185
  CrossrefPubMedGoogle Scholar
• 9 Seibel I, Hager A, Duncker T. et al. Anti-VEGF therapy in symptomatic peripheral exudative hemorrhagic chorioretinopathy (PEHCR) involving the macula. Graefes Arch Clin Exp Ophthalmol 2016; 254: 653-659
  CrossrefPubMedGoogle Scholar
• 10 Kirchhof P, Benussi S, Kotecha D. et al. ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37: 2893-2962
  CrossrefPubMedGoogle Scholar
• 11 von Ryan SJ, Schachat AP, Wilkinson CP. et al. Retina, Vol 1 (Part 1) Retinal Imaging and Diagnostics. 5th edition. USA: Elsevier Saunders; 2013
  Google Scholar
• 12 Mantel I, Schalenbourg A, Zografos L. Peripheral exudative hemorrhagic chorioretinopathy: polypoidal choroidal vasculopathy and hemodynamic modifications. Am J Ophthalmol 2012; 153: 910-922
  CrossrefPubMedGoogle Scholar
• 13 Mashayekhi A, Shields CL, Shields JA. Peripheral Exudative Hemorrhagic Chorioretinopathy: A Variant of Polypoidal Choroidal Vasculopathy?. J Ophthalmic Vis Res 2013; 8: 264-267
  PubMedGoogle Scholar
• 14 Goldman DR, Freund KB, McCannel CA. et al. Peripheral polypoidal choroidal vasculopathy as a cause of peripheral exudative hemorrhagic chorioretinopathy: a report of 10 eyes. Retina 2013; 33: 48-55
  CrossrefPubMedGoogle Scholar
• 15 Boltz A, Luksch A, Wimpissinger B. et al. Choroidal blood flow and progression of age-related macular degeneration in the fellow eye in patients with unilateral choroidal neovascularization. Invest Ophthalmol Vis Sci 2010; 51: 4220-4225
  CrossrefPubMedGoogle Scholar
• 16 Pauleikhoff D, Spital G, Radermacher M. et al. A fluorescein and indocyanine green angiographic study of choriocapillaris in age-related macular disease. Arch Ophthalmol 1999; 117: 1353-1358
  CrossrefPubMedGoogle Scholar
• 17 Madhusudhan S, Beare N. Wide-field fluorescein angiography in wet age-related macular degeneration. ScientificWorldJournal 2014; 2014: 536161
  PubMedGoogle Scholar
• 18 Singer M, Sagong M, van Hemert J. et al. Ultra-widefield imaging of the peripheral retinal vasculature in normal subjects. Ophthalmology 2016; 123: 1053-1059
  CrossrefPubMedGoogle Scholar
• 19 Spitznas M, Bornfeld N. The architecture of the most peripheral retinal vessels. Albrecht Von Graefes Arch Klin Exp Ophthalmol 1977; 203: 217-229
  CrossrefPubMedGoogle Scholar
• 20 Lu J, Mai G, Luo Y. et al. Appearance of far peripheral retina in normal eyes by ultra-widefield fluorescein angiography. Am J Ophthalmol 2017; 173: 84-90
  CrossrefPubMedGoogle Scholar
• 21 Panda-Jonas S, Jonas JB, Jakobczyk-Zmija M. Retinal pigment epithelial cell count, distribution, and correlations in normal human eyes. Am J Ophthalmol 1996; 121: 181-189
  CrossrefPubMedGoogle Scholar
• 22 Delori FC, Dorey CK, Staurenghi G. et al. In vivo fluorescence of the ocular fundus exhibits retinal pigment epithelium lipofuscin characteristics. Invest Ophthalmol Vis Sci 1995; 36: 718-729
  PubMedGoogle Scholar
• 23 Heussen FM, Tan CS, Sadda SR. Prevalence of peripheral abnormalities on ultra-widefield greenlight (532 nm) autofluorescence imaging at a tertiary care center. Invest Ophthalmol Vis Sci 2012; 53: 6526-6531
  CrossrefPubMedGoogle Scholar
• 24 Guduru A, Fleischman D, Shin S. et al. Ultra-widefield fundus autofluorescence in age-related macular degeneration. PLoS One 2017; 12: e0177207
  CrossrefPubMedGoogle Scholar
• 25 Witmer MT, Kozbial A, Daniel S. et al. Peripheral autofluorescence findings in age-related macular degeneration. Acta Ophthalmol 2012; 90: e428-e433
  CrossrefPubMedGoogle Scholar
• 26 Tan CS, Heussen F, Sadda SR. Peripheral autofluorescence and clinical findings in neovascular and non-neovascular age-related macular degeneration. Ophthalmology 2013; 120: 1271-1277
  CrossrefPubMedGoogle Scholar
• 27 Lengyel I, Csutak A, Florea D. et al. A Population-Based Ultra-Widefield Digital Image Grading Study for Age-Related Macular Degeneration-Like Lesions at the Peripheral Retina. Ophthalmology 2015; 122: 1340-1347
  CrossrefPubMedGoogle Scholar
• 28 Tadros C, Delyfer M, Rougier 3rd MB. et al. Peripheral retinal changes in elderly subjects: the Alienor study. Invest Ophthalmol Vis Sci 2012; 53: 3826
  PubMedGoogle Scholar
• 29 Lim TH, Laude A, Tan CS. Polypoidal choroidal vasculopathy: an angiographic discussion. Eye (Lond) 2010; 24: 483-490
  CrossrefPubMedGoogle Scholar
• 30 Sho K, Takahashi K, Yamada H. et al. Polypoidal choroidal vasculopathy: incidence, demographic features, and clinical characteristics. Arch Ophthalmol 2003; 121: 1392-1396
  CrossrefPubMedGoogle Scholar
• 31 Uyama M, Wada M, Nagai Y. et al. Polypoidal choroidal vasculopathy: natural history. Am J Ophthalmol 2002; 133: 639-648
  CrossrefPubMedGoogle Scholar
• 32 Spaide RF, Yannuzzi LA, Slakter JS. et al. Indocyanine green videoangiography of idiopathic polypoidal choroidal vasculopathy. Retina 1995; 15: 100-110
  CrossrefPubMedGoogle Scholar
• 33 Akaza E, Mori R, Yuzawa M. Long-term results of photodynamic therapy of polypoidal choroidal vasculopathy. Retina 2008; 28: 717-722
  CrossrefPubMedGoogle Scholar
• 34 Wakabayashi T, Gomi F, Sawa M. et al. Marked vascular changes of polypoidal choroidal vasculopathy after photodynamic therapy. Br J Ophthalmol 2008; 92: 936-940
  CrossrefPubMedGoogle Scholar
• 35 Lee WK, Lee PY, Lee SK. Photodynamic therapy for polypoidal choroidal vasculopathy: vaso-occlusive effect on the branching vascular network and origin of recurrence. Jpn J Ophthalmol 2008; 52: 108-115
  CrossrefPubMedGoogle Scholar
• 36 Barkmeier AJ, Kadikoy H, Holz ER. et al. Regression of serous macular detachment due to peripheral exudative hemorrhagic chorioretinopathy following intravitreal bevacizumab. Eur J Ophthalmol 2011; 21: 506-508
  CrossrefPubMedGoogle Scholar
• 37 Pinarci EY, Kilic I, Bayar SA. et al. Clinical characteristics of peripheral exudative hemorrhagic chorioretinopathy and its response to bevacizumab therapy. Eye (Lond) 2013; 27: 111-112
  CrossrefPubMedGoogle Scholar
• 38 Takayama K, Enoki T, Kojima T. et al. Treatment of peripheral exudative hemorrhagic chorioretinopathy by intravitreal injections of ranibizumab. Clin Ophthalmol 2012; 6: 865-869
  PubMedGoogle Scholar