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Neovaskularisationsglaukom

Ätiologie, Pathogenese und Therapie

Neovascular glaucoma

Aetiology, pathogenesis and treatment

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Zusammenfassung

Das Neovaskularisationsglaukom ist als typisches Sekundärglaukom Folge okulärer oder systemischer (Vor-)Erkrankungen. Durch Ausbildung einer fibrovaskulären Membran auf der Irisvorderfläche (Rubeosis iridis) bis in den Kammerwinkel kommt es zu einer irreversiblen Verlegung des Abflusssystems mit entsprechender Drucksteigerung. Die häufigste Ursache ist eine retinale Ischämie, bedingt durch einen Gefäßverschluss oder diabetische Veränderungen. Differenzialdiagnostisch müssen v. a. das akute Winkelblockglaukom oder auch ein dekompensiertes Offenwinkelglaukom abgegrenzt werden. Die Behandlung hat die Beseitigung der Ursache oder zumindest eine Reduktion der Risikofaktoren zum Ziel (z. B. durch Laserkoagulation der Netzhaut) oder besteht aus zyklodestruktiven Maßnahmen. Medikamentös kommen gefäßabdichtende (Steroide, Zykloplegika) und kammerwasserproduktionshemmende Substanzen (Carboanhydrasehemmer, β-Blocker) sowie in Zukunft möglicherweise antiangiogenetisch wirksame Präparate zur Anwendung. Auch der Einsatz von Dränageimplantaten wird diskutiert.

Abstract

Neovascular glaucoma, as a typical secondary glaucoma, is due to ocular or (earlier) systemic diseases. The formation of a fibrovascular membrane on the anterior surface of the iris (rubeosis iridis) and extending into the chamber angle leads to irreversible obliteration of the outflow system, with a corresponding rise in intraocular pressure. The most frequent cause is retinal ischaemia resulting either from vascular occlusion or from diabetic alterations. The differential diagnosis must include acute angle-closure glaucoma and uncontrolled open-angle glaucoma. Treatment is aimed at eliminating the actual cause or at least reducing the risk factors (e.g. by retinal laser coagulation), or consists in cyclodestructive procedures. Medicamentous therapy comprises anti-inflammatory agents (steroids, cycloplegic agents) and substances that reduce the production of aequeous humour (carbonic anhydrase antagonists, beta blockers). In the near future, antiangiogenic medication might be another effective option. For end-stage neovascular glaucoma, the implantation of drainage devices is also discussed.

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  1. Universitäts-Augenklinik, Ernst-Abbe-Straße 2, 53127 , Bonn

    K. U. Löffler

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  1. K. U. Löffler
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Löffler, K.U. Neovaskularisationsglaukom. Ophthalmologe 103, 1057–1064 (2006). https://doi.org/10.1007/s00347-006-1431-7

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  • DOI: https://doi.org/10.1007/s00347-006-1431-7

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