Zusammenfassung
Der erhöhte Augeninnendruck ist derzeit der einzige beeinflussbare Risikofaktor für das Glaukom. Bei einer okulären Hypertension ist zwar der Augeninnendruck erhöht, Papille und Gesichtsfeld sollen keine Schäden aufweisen. Die Abgrenzung zum Glaukom anhand der Papille lässt sich häufig nur im Verlauf treffen, weil die Schnittmenge zwischen noch normalen und bereits pathologischen Befunden groß ist. In der „Ocular Hypertension Treatment Study“ (OHTS) wurde die Effektivität einer prophylaktischen Behandlung gezeigt, in der OHTS und der „European Glaucoma Prevention Study“ (EGPS) wurden Risikofaktoren gefunden, die eine Konversion zum Glaukom begünstigen. Es handelt sich um den Augeninnendruck, die Größe der Exkavation im Vergleich zur Papillenfläche, eine geringe zentrale Hornhautdicke, die erhöhte „pattern standard deviation“ in der statischen Perimetrie und das Alter. Die prophylaktische Behandlung der okulären Hypertension sollte sich an diesen Risikofaktoren und der speziellen persönlichen Situation der Patienten orientieren und individuell abgewogen werden. Je höher der Augeninnendruck, je geringer die zentrale Hornhautdicke, je größer die Papillenexkavation und je jünger der Patient, desto eher sollte die Behandlung begonnen werden.
Abstract
Increased intraocular pressure is currently the only manipulable risk factor for glaucoma. In ocular hypertension the intraocular pressure is increased but the optic nerve head and visual field are thought to show no damage. Classification into glaucoma by means of the optic nerve head is often possible only over a period of time because there is a large overlap between the already pathological and still normal findings. In the Ocular Hypertension Treatment Study (OHTS) the effectiveness of prophylactic treatment was demonstrated. In the OHTS and the European Glaucoma Prevention Study (EGPS) risk factors have been identified, such as increased intraocular pressure, size of the excavation of the optic nerve head, decreased central corneal thickness, increased pattern standard deviation in the visual field and age. Before treatment of ocular hypertension is initiated these risk factors and the patient’s personal situation should be considered. The higher the intraocular pressure, the smaller the central corneal thickness and the larger the excavation of the optic nerve and the younger the patient, the earlier treatment should be started.
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Wahl, J. Argumente für eine prophylaktische Therapie der okulären Hypertension. Ophthalmologe 108, 1011–1015 (2011). https://doi.org/10.1007/s00347-011-2431-9
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DOI: https://doi.org/10.1007/s00347-011-2431-9