Kindliche Glaukomerkrankungen

Zusammenfassung

Glaukomerkrankungen im Kindesalter sind selten. Da ohne Behandlung in der Regel die Erblindung eintritt, ist eine umgehende Diagnosestellung und Therapie von höchster Bedeutung. Die Heterogenität der Erkrankung erfordert eine genaue Kenntnis der möglichen Ursachen und deren individuelle Behandlung. Dieser Artikel soll einen Überblick über die kindlichen Glaukome vermitteln und die wichtigsten Aspekte der Therapie aufzeigen.

Abstract

Childhood glaucoma is a rare disease. Since a lacking therapy normally leads to blindness an immediate diagnosis and appropriate treatment are crucial. The heterogeneity of childhood glaucoma requires a comprehensive knowledge of possible underlying pathomechanisms of primary and secondary childhood glaucoma types. Several types of childhood glaucoma are accompanied with ocular or systemic syndromes and hereditary causes are frequent. Thus, an interdisciplinary team of ophthalmologists, orthoptists, pediatricians, human geneticists, and anesthesiologists is vital for a successful supply. Most cases rely on a dysgenesis of trabecular meshwork with impaired outflow. Thus, usually a surgical approach is indicated. To handle a surgery in a buphthalmic eye an experienced hand is required. Special attention should be paid on the correct prescription of topical antiglaucomatous therapy in children since they are more prone to develop side effects. This article aims to provide an overview about the different childhood glaucoma types and to point out the most important aspects of their individual treatment strategies.

Kernaussagen

• Die Inzidenz des primären kongenitalen Glaukoms (PCG) liegt in westlichen Ländern bei 1 : 10000 bis 1 : 30000; Sekundärglaukome sind noch seltener.

• Es liegt bei hereditärer Form ein autosomal-rezessiver Erbgang zugrunde mit Mutationen in verschiedenen Genen.

• Eine Dysgenesie des Kammerwinkels, insbesondere des Trabekelmaschenwerks und des Schlemm-Kanals sind Ursache des PCGs.

• Bei Kindern muss die Untersuchung meist in Narkose erfolgen.

• Sekundärglaukome können aufgrund von nicht erworbenen okulären Anomalien, systemischen oder erworbenen okulären Erkrankungen oder nach Kataraktoperationen auftreten.

• Eine rein konservative medikamentöse Therapie ist meist nicht ausreichend erfolgreich.

• Operativ lassen sich kindliche Glaukome mit Kammerwinkelchirurgie, filtrierenden oder zyklodestruktiven Eingriffen beheben.

• Die orthoptische Anbindung ist bei Kindern mit Glaukom für eine optimale Visusentwicklung nach der Operation unabdingbar.

• Lebenslange augenärztliche Kontrollen sind notwendig.

Schlüsselwörter

Primäres kongenitales Glaukom - Vorderabschnittsdysgenesie - CYP1B1 - Narkoseuntersuchung - Trabekulotomie

Key words

Primary congenital glaucoma - anterior segment dysgenesis - CYP1B1 - examination under anesthesia - trabeculotomy

Publication History

Article published online:
25 May 2022

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