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Der Diabetologe

, Volume 14, Issue 8, pp 550–556 | Cite as

Klinische Stadieneinteilung der diabetischen Retinopathie

  • Focke Ziemssen
  • Lydia Marahrens
  • Daniel Roeck
  • Hansjürgen Agostini
Leitthema
  • 32 Downloads

Zusammenfassung

Die Stadien der diabetischen Retinopathie ermöglichen die Bewertung des Progressionsrisikos und davon abhängig die Entscheidung über therapeutische Konsequenzen. Morphologische Veränderungen weisen eine große Heterogenität in Bezug auf ihre Lokalisation und Interpretation auf: Mikroaneurysmen können teilweise reversibel sein; retinale Blutungen sind nicht notwendigerweise spezifisch durch den Diabetes bedingt. In der historischen Entwicklung ist ein Abrücken der Einteilungen von der Berücksichtigung einzelner Läsionen festzustellen.

Die automatische Bildanalyse konnte bisher bereits die Detektion kontroll- und behandlungsbedürftiger Befunde sicherstellen, ohne dass im Detail bekannt oder nachzuvollziehen ist, auf welcher Basis Maschinen im Einzelnen stratifizieren. Bevor die Verwendung historischer Stadien – im Interesse einer höheren Reproduzierbarkeit und Sensitivität – vollständig aufgegeben wird, sollte die Bedeutung neuer Definitionen und Diagnosekategorien in prospektiven Studien mit ausreichender Laufzeit validiert werden.

Früherkennungsuntersuchungen finden zumeist in einer Phase der Diabeteserkrankung statt, in der zwar (noch) keine Symptome oder Beeinträchtigungen bestehen, relevante Hinweise auf eine notwendige Therapieintensivierung aber bereits vorhanden sind.

Schlüsselwörter

Retina Diabetes mellitus Klassifikation Früherkennung Maschinelles Lernen 

Abkürzungen

DED

„Diabetic eye disease“

DMÖ

Diabetisches Makulaödem

DRIL

„Disorganisation of retinal inner layers“

DRS

„Diabetic retinopathy study“

ETDRS

„Early treatment of diabetic retinopathy study“

FAZ

Foveale avaskuläre Zone

FLA

Fluoreszenzangiographie

ICDR

„International clinical diabetic retinopathy and diabetic macular edema“

IRMA

Intraretinale mikrovaskuläre Anomalie

MA

Mikroaneurysmen

NPDR

Nichtproliferative diabetische Retinopathie

NVD

Neovaskularisation der Papille („disc“)

NVE

Neovaskularisationen „elsewhere“

OCT

Optische Kohärenztomographie

OCT-A

OCT-Angiographie

PDR

Proliferative diabetische Retinopathie

VEGF

„Vascular endothelial growth factor“

Clinical staging of diabetic retinopathy

Abstract

Staging of diabetic retinopathy allows the assessment of the risk of progression and, thus, a discussion and decision regarding the therapeutic approach. Morphologic changes show a large heterogeneity in terms of location, forms and interpretation: Microaneurysms can be reversible respectively transient, while retinal haemorrhages are not necessarily related to or specific for diabetes. More recently, classification places less emphasis on single lesions. Automated analysis systems and machine learning achieved to detect treatable and referable disease, although the distinguishing criteria are not known for all stratification layers. Before abandoning evaluations based on established stages in the interest of higher reproducibility and sensitivity, the predictive value of new categories and definition has to be validated in prospective trials of sufficient duration. When screening takes place, most of the affected persons do not perceive any symptoms (yet), but relevant indications for the intensification of treatment are already present.

Keywords

Retina Diabetes mellitus Classification Screening Machine learning 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

Die Autoren weisen auf folgende Beziehungen hin, obwohl sie sich um eine neutrale Darstellung bemüht haben: F. Ziemssen erhielt Unterstützung für Forschungsprojekte und klinische Studien von Alimera, Allergan, Bayer, Novartis; Zuwendungen für Beratung, Honorare und Reisekostenerstattungen von Alcon, Alimera, Allergan, Boehringer Ingelheim, Bayer, Novartis, NovoNordisk, Optos, MSD. L. Marahrens und D. Roeck erhielten Unterstützung für klinische Studien von Novartis und H. Agostini von Allergan, Bayer, Novartis, Zeiss, Roche.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • Focke Ziemssen
    • 1
  • Lydia Marahrens
    • 1
  • Daniel Roeck
    • 1
  • Hansjürgen Agostini
    • 2
  1. 1.Department für AugenheilkundeUniversität TübingenTübingenDeutschland
  2. 2.Klinik für AugenheilkundeUniversitätsklinikum FreiburgFreiburgDeutschland

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