Diagnostik und Therapie des Normaldruckglaukoms

Zusammenfassung

Gepoolte Daten der Studien „The Baltimore Eye Survey”, „The Blue Mountains Eye Study”, „The Beaver Dam Eye Study”, „The Rotterdam Study” und „The Melbourne VIP” ergeben eine stark altersabhängige Prävalenz von Offenwinkelglaukomen. Bis zu einem Alter von 60 Jahren beträgt die Häufigkeit von Offenwinkelglaukomen ca. 1 %. Ab dem 60. Lebensjahr steigt die Prävalenz exponenziell an. Personen in der 8. Lebensdekade weisen eine Prävalenz von ca. 5 % auf. 30 - 50 % dieser Patienten haben normale Augeninnendruckwerte. Die Diagnostik und Therapie von Offenwinkelglaukomen mit normalen Augeninnendruckwerten ist komplex und häufig fächerübergreifend. Als nachweisbare kausale Faktoren für die Entwicklung einer glaukomatösen Opticusatrophie bei NDG gelten: relativ erhöhter IOP, höheres Alter, zu niedriger (0 - 10 %) oder zu starker nächtlicher Blutdruckabfall (> 20 %), das Vorliegen einer „Small Vessel Disease” mit kardiovaskulären Erkrankungen und zerebralen mikrovaskulären Gliosen (WML), erniedrigter Randsaumblutfluss, verstärkter morgendlicher Abfall des Randsaumblutflusses, zerebrale Regulationsstörungen und ein erhöhtes Vorkommen des Epsilon4-Allels des Apolipoprotein-E-Gens. Es werden klinische Pfade zur Diagnostik und Therapie dieser Glaukomform dargestellt.

Abstract

Pooled data from “The Baltimore Eye Survey”, “The Blue Mountains Eye Study”, “The Beaver Dam Eye Study”, “The Rotterdam Study” and “The Melbourne VIP” showed a strong age-dependent prevalence of open angle glaucoma. Patients younger than 60 years have a prevalence of open angle glaucoma of less than 1 %. Beginning with the age of 60 the prevalence increases exponentially. The prevalence of open angle glaucoma in persons in the 8^th age decade reaches up to 5 %. Among these patients, 30 - 50 % have normal intraocular pressure. The diagnostics and therapy for open angle glaucoma with normal intraocular pressure (IOP), also called normal tension glaucoma, is a complex and often interdisciplinary challenge. Established causative factors for developing a glaucomatous optic nerve atrophy in normal tension glaucoma are: relatively increased IOP, older age, non-dippers (0 - 10 %) or extreme dippers (> 20 %) concerning nocturnal arterial blood pressure drop, small vessel disease with cardiovascular disease and cerebral microgliosis (white matter lesions), decreased blood flow in the optic nerve head, extreme dip of the optic nerve head blood flow in the morning, cerebral blood flow dysregulation and the epsilon4-allele polymorphism of the apolipoprotein E-gene. Clinical pathways are presented for the diagnostics and therapy for normal tension glaucoma.

Schlüsselwörter

Glaukom - Normaldruckglaukom - primäres Offenwinkelglaukom - neurovaskuläre Kopplung - White Matter Lesions - Endothelzelldysfunktion

Key words

Glaucoma - normal tension glaucoma - primary open angle glaucoma - neurovascular coupling - white matter lesions - endothelial dysfunction

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