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Der Ophthalmologe

, Volume 102, Issue 9, pp 909–918 | Cite as

Glaukomrisiko und Hornhautdicke

  • A. G. Böhm
Weiterbildung · Zertifizierte Fortbildung

Zusammenfassung

Der Augeninnendruck ist nach wie vor der wichtigste Risikofaktor für die Entstehung eines glaukomatösen Schadens. Neuere Studien weisen darauf hin, dass auch die Hornhautdicke ein Risikofaktor für die Entstehung einer glaukomatösen Schädigung darstellt. Eine mögliche Ursache hierfür könnte sein, dass die Hornhautdicke die Messung des Augeninnendruckes beeinflusst. Es konnte gezeigt werden, dass bei der Applanationstonometrie nach Goldmann die Messwerte mit der Hornhautdicke korrelieren. Dicke Hornhäute führen zu einer falsch hohen Messung des Augeninnendruckes und dünne zu einer falsch niedrigen. Ob es sich bei der Hornhautdicke als Risikofaktor für das Glaukom um einen reinen Messfehler oder einen Ausdruck biomechanischer Besonderheiten der Glaukomaugen handelt, ist nicht mit Sicherheit geklärt. Ein großer Teil des Hornhauteffektes beruht sicherlich auf dem Messfehler bei der Augeninnendruckmessung. Durch die Nichtberücksichtigung der Hornhautdicke können Messfehler entstehen, die zu Fehldiagnose und fehlerhafter Behandlung führen können. Aus diesem Grund sollte die Messung der Hornhautdicke bei Patienten mit einem Glaukom oder Glaukomverdacht nicht fehlen.

Schlüsselwörter

Hornhautdicke Glaukom Progression Tonometrie Augeninnendruck 

The risk of glaucoma and corneal thickness

Abstract

Intraocular pressure is still the most important risk factor for the development of glaucomatous optic nerve damage. There is growing evidence that corneal thickness is a risk factor for the development of glaucoma. This might be caused by the effect of corneal thickness on intraocular pressure (IOP) measurements. Goldmann applanation tonometry measurements are correlated with corneal thickness. Thick corneas lead to false high readings whereas thin corneas lead to false low readings. If corneal thickness as a risk factor for glaucoma is only related to the dependency of IOP measurements on corneal thickness or is related to possible different biomechanical tissue properties in glaucomatous eyes is not known. However, a large proportion of the corneal thickness effect seems to be related to the effect on IOP readings by applanation tonometry. Neglecting corneal thickness can lead to false measurements of IOP with consequent misdiagnosis and false treatment. Therefore, measurements of corneal thickness should be performed in glaucoma patients and suspects.

Keywords

Corneal thickness Glaucoma Progression Tonometry Intraocular pressure 

Notes

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Literatur

  1. 1.
    Aghaian E, Choe JE, Lin S, Stamper RL (2004) Central corneal thickness of Caucasians, Chinese, Hispanics, Filipinos, African Americans, and Japanese in a glaucoma clinic. Ophthalmology 111(12):2211–2219Google Scholar
  2. 2.
    Argus WA (1995) Ocular hypertension and central corneal thickness. Ophthalmology 102(12):1810–1812Google Scholar
  3. 3.
    Bohm A, Kohlhaas M, Lerche RC et al. (1997) Measuring intraocular pressure in keratoconus. Effect of the changed biomechanics. Ophthalmologe 94(11):771–774Google Scholar
  4. 4.
    Brandt JD (2004) Corneal thickness in glaucoma screening, diagnosis, and management. Curr Opin Ophthalmol 15(2):85–89Google Scholar
  5. 5.
    Brandt JD, Beiser JA, Kass MA, Gordon MO (2001) Central corneal thickness in the Ocular Hypertension Treatment Study (OHTS). Ophthalmology 108(10):1779–1788Google Scholar
  6. 6.
    Brandt JD, Beiser JA, Gordon MO, Kass MA (2004) Central corneal thickness and measured IOP response to topical ocular hypotensive medication in the Ocular Hypertension Treatment Study. Am J Ophthalmol 138(5):717–722Google Scholar
  7. 7.
    Bron AM, Creuzot-Garcher C, Goudeau-Boutillon S, d’Athis P (1999) Falsely elevated intraocular pressure due to increased central corneal thickness. Graefes Arch Clin Exp Ophthalmol 237(3):220–224Google Scholar
  8. 8.
    Browning AC, Bhan A, Rotchford AP et al. (2004) The effect of corneal thickness on intraocular pressure measurement in patients with corneal pathology. Br J Ophthalmol 88(11):1395–1339Google Scholar
  9. 9.
    Chen HC, Ho JD, Chang SH et al. (2004) Central corneal thickness of normal-tension glaucoma and non-glaucoma populations in ethnic Chinese. Chang Gung Med J 27(1):50–55Google Scholar
  10. 10.
    Copt RP, Thomas R, Mermoud A (1999) Corneal thickness in ocular hypertension, primary open-angle glaucoma, and normal tension glaucoma. Arch Ophthalmol 117(1):14–16Google Scholar
  11. 11.
    Ehlers N (1970) On corneal thickness and intraocular pressure. II. A clinical study on the thickness of the corneal stroma in glaucomatous eyes. Acta Ophthalmol (Copenh) 48(6):1107–1112Google Scholar
  12. 12.
    Ehlers N, Bramsen T, Sperling S (1975) Applanation tonometry and central corneal thickness. Acta Ophthalmol (Copenh) 53(1):34–43Google Scholar
  13. 13.
    Emara BY, Tingey DP, Probst LE, Motolko MA (1999) Central corneal thickness in lowtension glaucoma. Can J Ophthalmol 34(6):319–324Google Scholar
  14. 14.
    Goldmann H, Schmidt T (1957) Applanation tonometry. Ophthalmologica 134(4):221–242Google Scholar
  15. 15.
    Gordon MO, Beiser JA, Brandt JD et al. (2002) The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophthalmol 120(6):714–720; discussion 829–830Google Scholar
  16. 16.
    Hansen FK, Ehlers N (1971) Elevated tonometer readings caused by a thick cornea. Acta Ophthalmol (Copenh) 49(5):775–778Google Scholar
  17. 17.
    Heijl A, Leske MC, Bengtsson B et al. (2002) Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol 120(10):1268–1279Google Scholar
  18. 18.
    Henderson PA, Medeiros FA, Zangwill LM, Weinreb RN (2005) Relationship between central corneal thickness and retinal nerve fiber layer thickness in ocular hypertensive patients. Ophthalmology 112(2):251–256Google Scholar
  19. 19.
    Henriques MJ, Vessani RM, Reis FA et al. (2004) Corneal thickness in congenital glaucoma. J Glaucoma 13(3):185–188Google Scholar
  20. 20.
    Herman DC, Hodge DO, Bourne WM (2001) Increased corneal thickness in patients with ocular hypertension. Arch Ophthalmol 119(3):334–336Google Scholar
  21. 21.
    Herndon LW, Choudhri SA, Cox T et al. (1997) Central corneal thickness in normal, glaucomatous, and ocular hypertensive eyes. Arch Ophthalmol 115(9):1137–1141Google Scholar
  22. 22.
    Herndon LW, Weizer JS, Stinnett SS (2004) Central corneal thickness as a risk factor for advanced glaucoma damage. Arch Ophthalmol 122(1):17–21Google Scholar
  23. 23.
    Hewitt AW, Cooper RL (2005) Relationship between corneal thickness and optic disc damage in glaucoma. Clin Experiment Ophthalmol 33(2):158–163Google Scholar
  24. 24.
    Inoue K, Okugawa K, Oshika T, Amano S (2003) Morphological study of corneal endothelium and corneal thickness in pseudoexfoliation syndrome. Jpn J Ophthalmol 47(3):235–239Google Scholar
  25. 25.
    Johnson M, Kass MA, Moses RA, Grodzki WJ (1978) Increased corneal thickness simulating elevated intraocular pressure. Arch Ophthalmol 96(4):664–665Google Scholar
  26. 26.
    Jonas JB, Holbach L (2005) Central corneal thickness and thickness of the lamina cribrosa in human eyes. Invest Ophthalmol Vis Sci 46(4):1275–1279Google Scholar
  27. 27.
    Jonas JB, Stroux A, Velten I et al. (2005) Central corneal thickness correlated with glaucoma damage and rate of progression. Invest Ophthalmol Vis Sci 46(4):1269–1274Google Scholar
  28. 28.
    Kass MA, Heuer DK, Higginbotham EJ et al. (2002) The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol 120(6):701–713; discussion 829–830Google Scholar
  29. 29.
    Kaufmann C, Bachmann LM, Thiel MA (2003) Intraocular pressure measurements using dynamic contour tonometry after laser in situ keratomileusis. Invest Ophthalmol Vis Sci 44(9):3790–3794Google Scholar
  30. 30.
    Kim JW, Chen PP (2004) Central corneal pachymetry and visual field progression in patients with open-angle glaucoma. Ophthalmology 111(11):2126–2132Google Scholar
  31. 31.
    Kohlhaas M, Spörl E, Böhm AG et al. (2005) Applanationstonometrie bei Normalpatienten und Patienten nach LASIK. Klin Monatsbl Augenheilkd 198 (im Druck)Google Scholar
  32. 32.
    Lee GA, Khaw PT, Ficker LA, Shah P (2002) The corneal thickness and intraocular pressure story: where are we now? Clin Experiment Ophthalmol 30(5):334–337Google Scholar
  33. 33.
    Leske MC, Heijl A, Hussein M et al. (2003) Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial. Arch Ophthalmol 121(1):48–56Google Scholar
  34. 34.
    Mardelli PG, Piebenga LW, Whitacre MM, Siegmund KD (1997) The effect of excimer laser photorefractive keratectomy on intraocular pressure measurements using the Goldmann applanation tonometer. Ophthalmology 104(6):945–948; discussion 9Google Scholar
  35. 35.
    Medeiros FA, Sample PA, Weinreb RN (2003) Corneal thickness measurements and frequency doubling technology perimetry abnormalities in ocular hypertensive eyes. Ophthalmology 110(10):1903–1908Google Scholar
  36. 36.
    Medeiros FA, Sample PA, Weinreb RN (2003) Corneal thickness measurements and visual function abnormalities in ocular hypertensive patients. Am J Ophthalmol 135(2):131–137Google Scholar
  37. 37.
    Medeiros FA, Sample PA, Zangwill LM et al. (2003) Corneal thickness as a risk factor for visual field loss in patients with preperimetric glaucomatous optic neuropathy. Am J Ophthalmol 136(5):805–813Google Scholar
  38. 38.
    Mitchell P, Hourihan F, Sandbach J, Wang JJ (1999) The relationship between glaucoma and myopia: the Blue Mountains Eye Study. Ophthalmology 106(10):2010–2015Google Scholar
  39. 39.
    Morad Y, Sharon E, Hefetz L, Nemet P (1998) Corneal thickness and curvature in normaltension glaucoma. Am J Ophthalmol 125(2):164–168Google Scholar
  40. 40.
    Muir KW, Jin J, Freedman SF (2004) Central corneal thickness and its relationship to intraocular pressure in children. Ophthalmology 111(12):2220–2223Google Scholar
  41. 41.
    Orssengo GJ, Pye DC (1999) Determination of the true intraocular pressure and modulus of elasticity of the human cornea in vivo. Bull Mathemetical Biol 61:551–572Google Scholar
  42. 42.
    Patel S, McLaughlin JM (1999) Effects of central corneal thickness on measurement of intraocular pressure in keratoconus and post-keratoplasty. Ophthalmic Physiol Opt 19(3):236–241Google Scholar
  43. 43.
    Raj A, Sekhri R, Choudhuri I, Uppal S (2003) Corneal thickness measurements and visual function abnormalities in ocular hypertensive patients. Am J Ophthalmol 136(5):964–965; author reply 5–6Google Scholar
  44. 44.
    Shah S, Chatterjee A, Mathai M et al. (1999) Relationship between corneal thickness and measured intraocular pressure in a general ophthalmology clinic. Ophthalmology 106(11):2154–2160Google Scholar
  45. 45.
    Shih CY, Graff Zivin JS, Trokel SL, Tsai JC (2004) Clinical significance of central corneal thickness in the management of glaucoma. Arch Ophthalmol 122(9):1270–1275Google Scholar
  46. 46.
    Shimmyo M, Orloff PN (2005) Corneal thickness and axial length. Am J Ophthalmol 139(3):553–554Google Scholar
  47. 47.
    Shimmyo M, Ross AJ, Moy A, Mostafavi R (2003) Intraocular pressure, Goldmann applanation tension, corneal thickness, and corneal curvature in Caucasians, Asians, Hispanics, and African Americans. Am J Ophthalmol 136(4):603–613Google Scholar
  48. 48.
    The Advanced Glaucoma Intervention Study (AGIS) (2000) 7. The relationship between control of intraocular pressure and visual field deterioration.The AGIS Investigators. Am J Ophthalmol 130(4):429–440Google Scholar
  49. 49.
    Tielsch JM, Katz J, Singh K et al. (1991) A population-based evaluation of glaucoma screening: the Baltimore Eye Survey. Am J Epidemiol 134(10):1102–1110Google Scholar
  50. 50.
    Ventura AC, Bohnke M, Mojon DS (2001) Central corneal thickness measurements in patients with normal tension glaucoma, primary open angle glaucoma, pseudoexfoliation glaucoma, or ocular hypertension. Br J Ophthalmol 85(7):792–795Google Scholar
  51. 51.
    Whitacre MM, Stein RA, Hassanein K (1993) The effect of corneal thickness on applanation tonometry. Am J Ophthalmol 115(5):592–596Google Scholar
  52. 52.
    Wickham L, Edmunds B, Murdoch IE (2005) Central corneal thickness: will one measurement suffice? Ophthalmology 112(2):225–228Google Scholar
  53. 53.
    Wolfs RC, Klaver CC, Vingerling JR et al. (1997) Distribution of central corneal thickness and its association with intraocular pressure: The Rotterdam Study. Am J Ophthalmol 123(6):767–772Google Scholar

Copyright information

© Springer Medizin Verlag 2005

Authors and Affiliations

  1. 1.Klinik und Poliklinik für AugenheilkundeUniversitätsklinikum Carl Gustav CarusDresden
  2. 2.Universitäts-Augenklinik DresdenDresden

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