Diagnostische Möglichkeiten zur Früherkennung der Glaukomprogression

 

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Zusammenfassung

Einleitung: Zur Erfolgskontrolle der Glaukomtherapie ist die frühe Detektion einer Progression der wichtigste Verlaufsparameter. In dieser Übersicht sollen die Ergebnisse funktioneller und morphologischer Verfahren verglichen werden. Material und Methoden: Vor der Detektion einer Progression sollte man sich die Risikofaktoren aus den Interventionsstudien vergegenwärtigen und eine Risikostratifizierung durchführen. Die funktionellen Veränderungen der glaukomatösen Optikopathie werden durch die konventionelle Schwellenwertperimetrie, die Blau-Gelb- und frequenzverdoppelnde Perimetrie beschrieben. Darüber hinaus werden die morphologischen Veränderungen durch die Papillen- sowie Nervenfaserphotographie, Papillentomographie, die optische Kohärenztomographie und Nervenfaserpolarimetrie beschrieben. Ergebnisse: Die Risikofaktoren der bekannten Interventionsstudien sind: 1. erhöhter Augendruck, 2. schlechtere Durchschnittsabweichung („mean deviation”, MD), 3. höheres Alter, 4. Häufigkeit der Papillenrandblutungen. Bei Normaldruckglaukom konnte weiterhin der Migränekopfschmerz identifiziert werden. Bei einer okulären Hypertension waren ein erhöhter Inhomogenitätsindex („pattern standard deviation”, PSD), dünnere Hornhautdicke und größere vertikale „cup-to-disc”-Ratio mit einer Progression in ein Glaukom verbunden. Die Papillenphotographie war bisher das Verfahren der ersten Wahl in den longitudinalen Interventionsstudien. Vergleichende Untersuchungen zur Wertigkeit der Progressionsdetektion mit Hilfe der nervenfaserdicke- und papillenmorphologiebestimmenden Verfahren gibt es bisher nicht. Die standardisierte achromatische Schwellenwertperimetrie stellt das validierteste Verfahren der Progressionsdetektion dar. Die Blau-Gelb-Perimetrie und frequenzverdoppelnde Perimetrie zeigen Defekte früher und sind in der Detektion eines frühen Glaukomschadens von Vorteil. Zusammenfassung: Glaukompatienten sollten regelmäßig mit der Schwellenwertperimetrie und einer Papillenphotographie dokumentiert werden. Bei Patienten ohne bisherige Ausfälle sind die Blau-Gelb- und die frequenzverdoppelnde Perimetrie von Vorteil. Alternativen zur Dokumentation der Progression der glaukomatösen Optikopathie stellen nervenfaserdicke- und papillenmorphologiebestimmende Verfahren dar. Die Ergebnisse der Literatur für die Progressionsdetektion werden für jedes Verfahren dargestellt.

Abstract

Background: To monitor the efficiency of glaucoma therapy it is necessary to detect progression of the disease as soon as possible. This survey presents the results on functional and morphological approaches to detect glaucoma progression. Material and Methods: Risk factors identified in the therapeutic intervention studies should be used to evaluate the possible risk for progression. The functional test approaches of standard achromatic perimetry (SAP), short wavelength automated perimetry (SWAP) and frequency doubling technology (FDT) are described. Furthermore, morphologic changes are described by means of optic nerve head and nerve fiber photography, optic nerve head tomography, optic coherence tomography and nerve fiber polarimetry. Results: The risk factors identified in the interventional studies were as follows: 1. higher intraocular pressure, 2. worse mean deviation (MD), 3. older age, and 4. frequent disc hemorrhages. Additionally, in patients with normal pressure glaucoma, migraine headaches were identified. Patients with ocular hypertension showed a higher risk of conversion into open angle glaucoma in case of higher pattern standard deviation (PSD), thinner central corneal thickness and larger vertical cup-to-disc ratio. The optic nerve head photography was the standard procedure of morphological monitoring in the interventional studies. A direct comparison of the available techniques on nerve fiber thickness and optic nerve head morphology is not yet available. SAP represents the functional methodology with the most validated results. SWAP and FDT showed that progression in early glaucoma can be detected before SAP damage occurs. Conclusion: Glaucoma patients should be regularly tested with SAP and optic nerve head photography. Automated nerve fiber or optic nerve head morphology measuring techniques might be favourable to complete the diagnostic monitoring. In patients without glaucomatous damage SWAP and FDT may be able to detect changes earlier than SAP. The results of a review of the literature are presented and discussed for each technology.

Publication History

Received: 09 July 2005

Accepted: 09 September 2005

Publication Date:
21 March 2006 (online)

© 2006. Thieme. All rights reserved.

Georg Thieme Verlag KG Stuttgart · New York

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