Retinale arterielle Makroaneurysmen (RAM) – Pathologie, Differenzialdiagnose und Therapie

 

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Zusammenfassung

Retinale arterielle Makroaneurysmen (RAM) sind unilaterale, solitäre, rundliche oder spindelförmige Dilatationen der retinalen Arteriolen nach arteriellen Bifurkationen 1.–3. Ordnung. Patienten höheren Lebensalters (weiblich > männlich) mit arteriellem Hypertonus sind vornehmlich betroffen. Prädilektionsstellen sind arterielle Aufzweigungen oder arteriovenöse Kreuzungen am hinteren Pol. Bei einfachen RAM stehen nur die Gefäßektasien im Vordergrund. Sie bleiben asymptomatisch und sind meist ein Zufallsbefund. Komplexe RAM gehen mit begleitenden exsudativen Veränderungen einher und werden durch ein Makulaödem symptomatisch. Hämorrhagische Komplikationen treten durch Ruptur des RAM auf, wobei prä-, intra- und subretinale Blutungen entstehen können. Dieser Übersichtsartikel setzt sich darüber hinaus mit den konservativen und chirurgischen Therapiemaßnahmen auseinander.

Abstract

Retinal arterial macroaneurysms (RAM) are unilateral, solitary, acquired saccular or fusiform dilatations of the large arterioles of the retina, usually within the first three orders of bifurcation. They are associated with systemic vascular conditions such as hypertension and arteriosclerotic disease and occur most commonly in elderly women. Cases of simple RAM are predominated by the vascular ectasia. These macroaneurysms regress without treatment and without causing decreased visual acuity and will usually remain undetected. Complex RAM often go along with vision loss due to haemorrhage or oedema affecting the macula. Poor visual outcome may occur secondary to foveal exudates and subfoveal haemorrhage, the latter appear as pre-retinal, intra-, and subretinal haemorrhage. This overview discusses conservative and surgical therapeutic options for complex cases.

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