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Klin Monbl Augenheilkd 2018; 235(05): 576-585
DOI: 10.1055/a-0573-9598
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Sekundärglaukom bei Uveitis

Uveitic Secondary Glaucoma
Claudia Lommatzsch
1   Augenabteilung am St. Franziskus-Hospital Münster
,
Carsten Heinz
1   Augenabteilung am St. Franziskus-Hospital Münster
2   Universitätsaugenklinik, Universitätsklinikum Essen
› Author Affiliations
Further Information

Publication History

eingereicht 14 January 2018

akzeptiert 02 February 2018

Publication Date:
08 May 2018 (online)

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Zusammenfassung

Ein Augeninnendruckanstieg mit Entwicklung von glaukomatösen Schäden ist eine häufige Komplikation im Rahmen einer Uveitis. Die Prävalenz hat eine große Spannbreite in Abhängigkeit von unterschiedlichen Faktoren wie z. B. der zugrunde liegenden Uveitisform und der Erkrankungsdauer. Pathogenetisch muss zwischen einer sekundären Engwinkelkomponente und dem häufiger auftretenden Offenwinkelglaukom unterschieden werden. In der Diagnostik kommt neben der klinischen Sehnervenkopfbeurteilung, Perimetrie und Tonometrie die Verwendung von bildgebenden Untersuchungsgeräten wie z. B. OCT oder HRT zum Tragen. Im Rahmen eines uveitischen Glaukoms können die glaukomtypischen Veränderungen im Vergleich zu anderen Glaukomformen geringer ausgeprägt sein bzw. durch Netzhautschwellungen kaschiert werden. Therapeutisch ist die medikamentöse Therapie in Form von augeninnendrucksenkenden Augentropfen weiterhin First-Line-Empfehlung, wobei die Verwendung von lokalen Karboanhydrasehemmern oder Betablockern, je nach vorliegenden Kontraindikationen, primär zu bevorzugen ist. Eine operative Therapie schließt sich an eine erfolglose oder unzureichende konservative Therapie an. Die adäquate Operationstechnik ist vom jeweiligen Befund abhängig und umfasst zurzeit vorrangig Techniken wie filtrierende Operationen oder Glaukomdrainage-Implantate.

Abstract

An intraocular pressure increase with development of glaucomatous damage is a common complication of uveitis. The prevalence has a wide range depending on various factors such as the underlying uveitis type and the duration of the disease. Pathogenetically, a distinction must be made between a secondary angle closure component and the more frequently occurring open-angle glaucoma. In diagnostics, in addition to the clinical optic nerve head assessment, perimetry and tonometry, the use of imaging examination equipment, such as OCT and HRT, are recommended. In the context of uveitic glaucoma, it must be considered in the evaluation, because the glaucoma-typical changes are generally less pronounced or can be concealed by retinal swelling in comparison with other forms of glaucoma. Therapeutically, drug therapy in the form of eye drops continues to be a first-line recommendation, with the use of topical carbonic anhydrase inhibitors or beta-blockers primarily preferred, depending on the contraindications. An operative therapy follows after unsuccessful or inadequate conservative therapy: the adequate surgical technique depends on the respective finding and includes actually techniques such as filtering procedures and glaucoma drainage devices.

Schlüsselwörter

Uveitis - Glaukom - Pathogenese - Diagnostik - Therapie

Key words

uveitis - glaucoma - pathogenesis - diagnostics - therapy
 

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