Rheohaemapheresis of ophthalmological diseases and diseases of the microcirculation.

Blood rheology was considered to be of limited clinical importance, until extracorporeal technologies enabling the treatment of cellular and plasmatic hyperviscosity syndromes were introduced. However, a wide range of applications, mainly referring to rheologically determined diseases of the microcirculation exists but has so far hardly been taken into consideration. The extension of indications was due to modern technical developments leading to different approaches of secondary separation such as precipitation, ad- or absorption and filtration. Based on 18 years of experience with different separation technologies the combination of some centrifugal devices applied for cell--plasma separation with secondary filtration (Rheohemapheresis) appears to be the most efficacious and economical approach for such extracorporeal treatments. The sequence and frequency of rheohaemapheresis treatments depends on the measurement of rheological measurements in combination with clinical--chemical data which are related to the distribution kinetics and synthesis rate of both blood cells and plasma proteins. Standardised treatment protocols proved the efficacy of initial therapies and were applied for controlled trials whereas long term therapies may need more flexible treatment approaches. So far an increasing experience exists for the treatment of ophthalmologic diseases, otologic disorders, diabetic complications and cardiological diseases. Rheohemapheresis was shown to be a safe treatment approach, if a careful risk assessment prior to the initiation of the therapies is performed. The treatment cannot cure diseases but enables a substantial improvement of the quality of life in patients without treatment alternatives.