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Hypertone Veränderungen des Fundus

Hypertensive changes of the fundus

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Zusammenfassung

Die arterielle Hypertonie betrifft etwa ein Viertel der Weltbevölkerung und gilt als wichtigster Risikofaktor für kardiovaskuläre Erkrankungen. Die hypertonen Fundusveränderungen lassen sich in eine Retinopathie, eine Chorioidopathie und eine Optikopathie gliedern. Der Schweregrad der Retinopathie orientiert sich einerseits am Ausmaß der arteriolären Gefäßverengung, andererseits am Vorhandensein von Parenchymveränderungen wie Blutungen, Cotton-wool-Flecken oder harten Exsudaten. Da sich der Grad der Gefäßverengung nur schwer quantifizieren lässt und im höheren Lebensalter zusätzlich durch arteriosklerotische Veränderungen überlagert ist, wird in einem vereinfachten Schema ein leichteres Stadium mit reinen Gefäßveränderungen von einer schweren Retinopathie mit Parenchymveränderungen abgegrenzt. Eine Untersuchung der Netzhaut ist in erster Linie sinnvoll bei einer schweren Hypertonie, bei akuten Sehstörungen, bei Diabetes mellitus sowie in der Schwangerschaft.

Abstract

Systemic hypertension affects approximately 25 % of the population worldwide and is the most important preventable risk factor for cardiovascular diseases. Hypertension-related fundus abnormalities can be classified into hypertensive retinopathy, choroidopathy, and optic neuropathy. Hypertensive retinopathy causes vascular constriction of retinal arterioles and typical fundus findings, such as blot hemorrhages, hard exudates and cotton wool spots resulting from ischemia within the nerve fiber layer. The use of a detailed grading system based on the severity of vascular constriction is not practicable as arteriosclerotic changes are common among elderly people. Therefore, early stages with pure vascular pathology should be differentiated from severe forms of hypertensive retinopathy with parenchymal changes of the fundus. Screening the retina for hypertensive changes is essential in cases of severe systemic hypertension, acute visual impairment, diabetes mellitus and pregnancy.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. W. Göbel und J. Matlach geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Augenklinik und Poliklinik, Universitätsklinikum Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Deutschland

    W. Göbel & J. Matlach

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  1. W. Göbel
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  2. J. Matlach
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Correspondence to W. Göbel.

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Göbel, W., Matlach, J. Hypertone Veränderungen des Fundus. Ophthalmologe 110, 995–1007 (2013). https://doi.org/10.1007/s00347-013-2953-4

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