Sekundärerkrankungen bei hoher Myopie

ZusammenfassungHintergrundAugen mit hoher Myopie (Achslänge ≥ 26,5 mm) weisen nicht einfach nur einen Größenunterschied auf. Angesichts morphologischer und struktureller Veränderungen erklärt sich das erhöhte Risiko für verschiedene Sekundärerkrankungen.FragestellungBetrachtet werden Inzidenz und Mortalität von Augenerkrankungen bei hoher Myopie. Außerdem erfolgt eine Darstellung von deren Ursachen und Klinik.Material und MethodeEs erfolgten eine systematische Literaturanalyse, Diskussion von Grundlagenarbeiten und epidemiologischen Analysen.ErgebnisseChoroidale Neovaskularisation (adjustierte Prävalenz: 2,5–5 %), Staphylome, Foveoschisis und periphere Netzhautdegenerationen sind Beispiele für Probleme, die zur erhöhten Rate von Sehbehinderung und Blindheit beitragen. Hohe Myopie ist mit einem deutlich erhöhten Ablatiorisiko nach Linsenchirurgie assoziiert (Hazard Ratio 6,1), insbesondere noch häufiger bei jüngeren Menschen. Das assoziierte Offenwinkelglaukom (Odds Ratio: 2,46) wird nicht selten wegen relativ niedriger Druckwerte erst spät erkannt.SchlussfolgerungenDas Verständnis um Dehnungsherde und Staphylome hat sehr von den Fortschritten der Bildgebung profitiert (Magnetresonanztomographie, Kohärenztomographie, Weitwinkelaufnahmen), die frühere histologische Beobachtungen ergänzt und erklärt. Das Wissen um das Risikoprofil ist für den ärztlichen Alltag von hoher Relevanz.AbstractBackgroundEyes with high myopia (axial length ≥ 26.5 mm) do not just have a different size. Due to morphological and structural changes there is a considerably increased risk for many different secondary diseases.ObjectiveDetermination of the incidence and mortality in high myopia, discussion of effects and clinical signs, presentation of treatment recommendations and counselling.Material and methodsA systematic search of the literature was carried out and a discussion on basic principles and epidemiological investigations is presented.ResultsFindings due to high myopia are not in a closed state but undergo continuous changes. Choroidal neovascularization (adjusted prevalence 2.5–5%), staphyloma, foveoschisis and peripheral retinal degeneration are examples of problems contributing to the increased rate of visual impairment and blindness related to myopia. High myopia is associated with a clearly increased risk of retinal detachment after lens surgery (hazard ratio 6.1) and particularly more frequently in younger people. The associated primary open-angle glaucoma (odds ratio 2.46) is often recognized too late due to relatively low values of intraocular pressure.ConclusionUnderstanding of atrophic areas and staphyloma has benefited from recent advances in imaging (e.g. magnetic resonance imaging, optical coherence tomography and wide-field imaging) that complement and explain histological findings. Knowledge of the associated risk profile is of major clinical relevance.

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