Die Bedeutung der arteriellen Hypertonie für das primäre Offenwinkelglaukom

Zusammenfassung

Das POWG ist gekennzeichnet durch ein multifaktorielles pathophysiologisches Geschehen, das durch eine Vielfalt von Risikofaktoren bestimmt wird. Obwohl der intraokulare Druck der derzeit bedeutendste Risikofaktor ist, reicht die alleinige Augendrucksenkung nicht aus, um in den meisten Fällen die glaukomatöse Optikusneuropathie zum Stillstand zu bringen. Deshalb werden zunehmend weitere Ansatzpunkte für die Glaukombehandlung wichtig. Die arterielle Hypertonie ist die häufigste Systemerkrankung bei Glaukompatienten und kommt bei jedem 2. Patienten vor. Neben ihrem geringen positiven Effekt auf den Augeninnendruck ist v. a. die negative Auswirkung auf die okuläre Durchblutung von Bedeutung. Dabei spielt weniger die arteriosklerotische Wirkung eine Rolle, sondern vielmehr die Auswirkungen der endothelialen Dysfunktion und der Regulationsstörungen mit zu geringen oder zu starken Tag-Nacht-Schwankungen des Blutdrucks. Die dadurch entstehenden Phasen der Ischämie und des Reperfusionsschadens können die glaukomatöse Optikusneuropathie ungünstig beeinflussen. Deshalb ist eine enge interdisziplinäre Zusammenarbeit zwischen Hausarzt/Internist/Kardiologe und Augenarzt notwendig, um das Glaukom langfristig stabil zu halten.

Abstract

Primary open-angle glaucoma is a multifactorial disease with a lot of different risk factors. Beside the fact that intraocular pressure (IOP) is the most important risk factor, the reduction of IOP alone is in most cases not sufficient to stop the progression of glaucoma. Therefore, other risk factors play also an important role. One of them is arterial hypertension, the most common systemic disease in glaucoma patients. Arterial hypertension increases IOP slightly, but has an important negative effect on ocular perfusion. Especially the endothelial dysfunction with a disturbed retinal autoregulation plays an important role. Therefore, ischaemic and reperfusion effects alter the optic nerve head and have negative input to the glaucomatous optic neuropathy. In future glaucoma patients should be monitored by ophthalmologists as well as by general physicians/cardiologists to optimise their treatment and to stabilise their glaucoma as well as possible.

Schlüsselwörter

Glaukom - arterielle Hypertonie - okulärer Perfusionsdruck - endotheliale Dysfunktion - Autoregulation

Key words

glaucoma - arterial hypertension - ocular perfusion pressure - endothelial dysfunction - autoregulation

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