Neurologische Erkrankungen und Glaukom – ein Überblick

Zusammenfassung

Aufgrund der anatomischen Lage des N. opticus zum Gehirn und seiner embryonalen Entwicklung als vorgeschobener Hirnanteil besteht zwischen den Optikopathien und bestimmten neurologischen Erkrankungen ein enger Zusammenhang. Das Glaukom hat als chronisch neurodegenerative Erkrankung viele zelluläre und molekulare Mechanismen mit den chronisch neurodegenerativen Erkrankungen im Gehirn gemeinsam. So sind z. B. erhöhte Spiegel von Biomarkern der Alzheimer-Erkrankung im Kammerwasser von Patienten mit primärem Offenwinkelglaukom gefunden worden. Auch ein verringerter Liquordruck ist bei Glaukompatienten und Alzheimer-Patienten nachgewiesen worden. Die entstehende translaminäre Druckdifferenz wird als einer der Pathomechanismen der Entstehung der Optikusatrophie bei beiden Erkrankungen gesehen. Andere Hypothesen wie Beeinflussung der Erkrankung bzw. der Pathogenese wie oxidativer Stess, Exzitotoxizität, mitochondriale Dysfunktionen, genetische Faktoren sowie vaskuläre Faktoren spielen bei den unterschiedlichen Erkrankungen eine gemeinsame Rolle. Experimentelle Studien konnten zeigen, dass auch in der Netzhaut dopaminerge amakrine Zellen vorhanden sind. Das Dopamin ist hier notwendig für die Lichtadaptation und zur Signalverarbeitung in den Stäbchen und Zapfen. Bei der Parkinson-Krankheit, welche mit einem Absterben der dopaminproduzierenden Nervenzellen z. B. in der Substantia nigra einhergeht, hat dies auch Auswirkungen auf das Auge und die afferente Signalverarbeitung. Dadurch kommt es bei Parkinson-Patienten zu Sehstörungen, Störungen in der Farbunterschiedsempfindlichkeit, und Abnahme der retinalen Nervenfaserschichtdicke mit allen ophthalmologischen Konsequenzen. Anhand der Beispiele Morbus Alzheimer, Morbus Parkinson und der chronisch entzündlichen Erkrankung multiple Sklerose soll exemplarisch der derzeit bekannte Zusammenhang zwischen den neurologischen Erkrankungen und der Optikusatrophie beim Glaukom in einer Übersicht dargestellt werden.

Abstract

Due to the anatomic location of the N. opticus to the brain and its embryological development as a “bulging part of the brain”, a close connection between the opticoneuropathy and certain neurological diseases exists. Glaucoma is a chronic neurodegenerative disorder and many cellular and molecular mechanisms of the chronic neurodegenerative diseases are common in the brain. For example, elevated levels of multiple biomarkers of Alzheimerʼs disease were found in the aqueous humor of patients with primary open-angle glaucoma. Also a decreased cerebrospinal fluid pressure (CSFP) has been demonstrated in patients with glaucoma and Alzheimerʼs disease. The resulting translaminar pressure difference is seen as one of the pathogenic mechanisms of the formation of the optic neuropathy in both diseases. Other hypotheses, such as the influence of oxidative stress, excitotoxicity, mitochondrial dysfunction, genetic factors and vascular factors play additional roles in the pathogenesis of the different diseases. Experimental studies have shown that dopaminergic amacrine cells are present in the retina. The dopamine in the retina is necessary for the light adaptation and the signal processing in the rods and cones. Parkinsonʼs disease is characterised by a loss of dopaminergic neurons in the basal ganglia-substantia nigra pars compacta of the midbrain. These decreased levels of dopamine also have an effect on the eye and the afferent signal processing. So there are reductions in visual acuity, disturbances in colour vision and contrast sensitivity and reduction of the retinal nerve fiber layer in patients affected with Parkinsonʼs disease. With the examples of Alzheimerʼs disease, Parkinsonʼs disease and the chronic inflammatory disease multiple sclerosis, we demonstrate the association between the neurological diseases and the opticoneuropathy in primary open-angle glaucoma.

Schlüsselwörter

Glaukom - Neuroophthalmologie - neurodegenerative Erkrankungen - Morbus Alzheimer - Morbus Parkinson - multiple Sklerose

Key words

glaucoma - neuroophthalmology - neurodegenerative disorders - Alzheimerʼs disease - Parkinsonʼs disease - multiple sclerosis

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