Sekundäre Neuroprotektion beim Glaukom durch Augendrucksenkung

Zusammenfassung

Das bisherige zentrale Ziel der Glaukombehandlung liegt darin, den intraokularen Druck (IOD) auf medikamentösem und/oder chirurgischem Weg zu senken, um ein weiteres Voranschreiten der Erkrankung über einen möglichst langen Zeitraum hin suffizient zu verhindern. Eine Stabilisierung des Gesichtsfeldes und des Nervenfasersaums der Papille wurden bisher als bestenfalls zu erreichende Ziele der Therapie des Glaukoms angesehen. Mittels einer systematischen Literaturrecherche und Analyse der bisher zum Thema Neuroprotektion und funktionelle Verbesserung durch Augendrucksenkung bei Glaukom veröffentlichten Untersuchungen sollen die bisher beschriebenen Möglichkeiten der anatomischen und funktionellen Wiederherstellung von vormals verloren gegangenen Strukturen und Funktionen beleuchtet werden. Im Rahmen verschiedener, teils groß angelegter Studien konnten bereits Hinweise für eine anatomische Befundverbesserung am Sehnervenkopf und funktionelle Verbesserungen in den Ergebnissen der Perimetrie gefunden werden. Anatomische sowie funktionelle Befundverbesserungen bei der Behandlung des Glaukoms scheinen in einigen Fällen tatsächlich vorzuliegen. Allerdings finden sich solche Befunde häufig in solchen Fällen, in denen der IOD sehr stark im Vergleich zum Ausgangsbefund gesenkt wurde.

Abstract

The central goal of glaucoma treatment is the reduction of intraocular pressure (IOP) by means of medication and/or surgery, in order to prevent further disease progression for as long as possible. Stabilising visual field defects and saving papillary neural tissue are seen as the optimal achievable aims in glaucoma therapy. We performed a systematic literature search and analysis of the published articles dealing with neuroprotection and functional improvement by IOP reduction in glaucoma. On this basis, the known options for anatomical and functional recovery of formerly lost structures and functions will be elucidated. Several studies – some large – have provided evidence for anatomical improvement at the optic nerve head and functional improvement in the results of visual field tests. After glaucoma treatment, there is anatomical and functional improvement in some patients. However, improvement is mostly detectable in patients whose IOP was greatly reduced.

Schlüsselwörter

Glaukom - Glaukomchirurgie - Perimetrie - Funktionsverbesserung - Glaukomtherapie

Key words

glaucoma - surgery - perimetry - functional improvement - glaucoma therapy

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