Hämodynamik des uvealen und des retinalen Kreislaufs und die diagnostischen Möglichkeiten

Diagnosis and therapy of retinal and uveal circulatory disorders should be based mainly on two pathophysiologic principles: (1) an autoregulation is effective in the retinal circulation only but absent in the choroidal circulation and (2) circulatory disorders may be caused not only by a reduced but also by an increased blood flow.The clinical evaluation of an individual retinal circulatory disoder depends on the interpretation of the dynamics of visual disurbances, detection of vascular type or fiber bundle defects in the visual field, repeated estimation of blood flow velocity by direct ophthalmoscopy or fluorescence antiography, and detection of specific fundus signs such as focal ischemia (cotton wool spots) or development of a collateral circulation and true neovascularization. For the indirect assessment of disturbances of the choroidal circulation certain subjective symptoms, alterations of the pigment epithelium, and edema and focal defects of the choriocapillaries are of importance. The stereobiomicroscopy of the fundus with a slitlamp and fluorescence angiographic studies of the sectorial distribution of the choroidal filling are valuable diagnostic aids.