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Diagnose und Therapie des Pseudoexfoliationsglaukoms

Diagnosis and therapy of pseudoexfoliation glaucoma

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Zusammenfassung

Das Pseudoexfoliations (PEX)-Glaukom ist die mit Abstand wichtigste und häufigste Form der Sekundärglaukome, die etwa 25% aller Offenwinkelglaukome weltweit ausmacht und gegenwärtig als die häufigste erkennbare Glaukomursache überhaupt gilt. Aufgrund hoher intraokularer Druckwerte, ausgeprägter Druckschwankungen und Druckspitzen, rapider Papillenschädigungen und rasch progredienter Gesichtsfeldausfälle gilt das PEX-Glaukom als besonders ernste, behandlungsintensive Glaukomform. Daher ist eine strikte Augeninnendrucksenkung erforderlich. Fixe Kombinationen in der medikamentösen Therapie und eine ggf. frühe Operation sind empfohlen. Im Zusammenhang mit dem operativen Vorgehen (selektive Lasertrabekuloplastik, Filterkissen-abhängige oder -unabhängige Verfahren) spielt der Zeitpunkt der Kataraktoperation eine große Rolle. Pathogenese, klinische Charakteristika und aktuelle therapeutische Aspekte des PEX-Glaukoms werden im folgenden Beitrag dargestellt.

Abstract

Pseudoexfoliation (PEX) glaucoma is the most frequent and most important type of secondary glaucoma, accounting for approximately 25% of open angle glaucoma worldwide and currently representing the most common identifiable cause of glaucoma overall. Due to high intraocular pressure levels, marked diurnal pressure fluctuations and spikes, and rapid optic nerve damage and visual field loss, PEX glaucoma represents a relatively severe and progressive type of glaucoma. Therefore, hard and fast lowering of intraocular pressure is necessary. Fixed combinations in medical therapy and early glaucoma surgery are recommended. When considering a surgical procedure (e.g. selective laser trabeculoplasty, bleb-dependent or bleb-independent surgery) the timing of cataract surgery plays a major role. Pathogenesis, clinical characteristics and therapeutic aspects of PEX glaucoma are described in the following article.

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Literatur

  1. Ritch R, Schlötzer-Schrehardt U (2001) Exfoliation syndrome. Surv Ophthalmol 45:265–315

    Article  PubMed  CAS  Google Scholar 

  2. Krause U, Alanko HI, Kärnä J et al (1988) Prevalence of exfoliation syndrome in Finland. Acta Ophthalmol Suppl 184:120–122

    PubMed  CAS  Google Scholar 

  3. Friederich R (1982) Eye disease in the Navajo Indians. Ann Ophthalmol 14:38–40

    PubMed  CAS  Google Scholar 

  4. Tarkkanen A (1986) Exfoliation glaucoma. Glaucoma 3:265–267

    Google Scholar 

  5. Ekström C (1993) Elevated intraocular pressure and pseudoexfoliation of the lens capsule as risk factors for chronic open-angle glaucoma. A population-based five-year follow-up study. Acta Ophthalmol (Copenh) 71:189–195

    Google Scholar 

  6. Thorleifsson G, Magnusson KP, Sulem P et al (2007) Common sequence variants in the LOXL1 gene confer susceptibility to exfoliation glaucoma. Science 317:1397–1400

    Article  PubMed  CAS  Google Scholar 

  7. Aström S, Stenlund H, Lindén C (2007) Incidence and prevalence of pseudoexfoliations and open-angle glaucoma in northern Sweden: II. Results after 21 years of follow-up. Acta Ophthalmol Scand 85:832–837

    Article  PubMed  Google Scholar 

  8. Jeng SM, Karger RA, Hodge DO et al (2007) The risk of glaucoma in pseudoexfoliation syndrome. J Glaucoma 16:117–121

    Article  PubMed  Google Scholar 

  9. Leske MC, Heijl A, Hyman L et al (2007) Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology 114:1965–1972

    Article  PubMed  Google Scholar 

  10. Davanger M, Rinvold A, Blika S (1991) Pseudo-exfoliation, IOP and glaucoma. Acta Ophthalmol 69:569–573

    CAS  Google Scholar 

  11. Armaly MF (1969) Interpretation of tonometry and ophthalmoscopy. Invest Ophthalmol 8:105–124

    PubMed  CAS  Google Scholar 

  12. Küchle M, Nguyen NX, Hannappel E, Naumann GO (1995) The blood-aqueous barrier in eyes with pseudoexfoliation syndrome. Ophthalmic Res 27(Suppl 1):136–142

    Article  PubMed  Google Scholar 

  13. Naumann GOH, Schlötzer-Schrehardt U, Küchle M (1998) Pseudoexfoliation syndrome for the comprehensive ophthalmologist. Intraocular and systemic manifestations. Ophthalmology 105:951–968

    Article  PubMed  CAS  Google Scholar 

  14. Schlötzer-Schrehardt U, Naumann GOH (2006) Perspective—ocular and systemic pseudoexfoliation syndrome. Am J Ophthalmol 141:921–937

    Article  PubMed  Google Scholar 

  15. Schlötzer-Schrehardt U (2010) Oxidative stress and pseudoexfoliation glaucoma. Klin Monatsbl Augenheilkd 227:108–113

    Article  PubMed  Google Scholar 

  16. Arnarsson A, Damji KF, Sasaki H et al (2009) Pseudoexfoliation in the Reykjavik Eye Study: five-year incidence and changes in related ophthalmologic variables. Am J Ophthalmol 148:291–297

    Article  PubMed  Google Scholar 

  17. Koliakos GG, Befani CD, Mikropoulos D et al (2008) Prooxidant-antioxidant balance, peroxide and catalase activity in the aqueous humour and serumof patients with exfoliation syndrome or exfoliative glaucoma. Graefes Arch Clin Exp Ophthalmol 246:1477–1483

    Article  PubMed  CAS  Google Scholar 

  18. Zenkel M, Kruse FE, Naumann GOH, Schlötzer-Schrehardt U (2007) Impaired cytoprotective mechanisms in eyes with pseudoexfoliation syndrome/glaucoma. Invest Ophthalmol Vis Sci 48:5558–5566

    Article  PubMed  Google Scholar 

  19. Rönkkö S, Rekonen P, Kaarniranta K et al (2007) Phospholipase A2 in chamber angle of normal eyes and patients with primary open angle glaucoma and exfoliation glaucoma. Mol Vis 13:408–417

    PubMed  Google Scholar 

  20. Blomster H, Puustjärvi T, Kontkanen M et al (2007) Asymmetric dimethylarginine is not elevated in exfoliation syndrome but symmetric dimethylarginine is related to exfoliative glaucoma. Graefes Arch Clin Exp Ophthalmol 245:204–209

    Article  PubMed  CAS  Google Scholar 

  21. Tyagi N, Sedoris KC, Steed M et al (2005) Mechanisms of homocysteine-induced oxidative stress. Am J Physiol Heart Circ Physiol 289:H2649–H2656

    Article  PubMed  CAS  Google Scholar 

  22. Jünemann AGM, Ahsen N von, Reulbach U et al (2005) C677T variant in the methylentetrahydrofolate reductase gene is a genetic risk factor for primary open-angle glaucoma. Am J Ophthalmol 139:721–723

    Article  PubMed  Google Scholar 

  23. Roedl JB, Bleich S, Reulbach U et al (2007) Vitamin deficiency and hyperhomocysteinemia in pseudoexfoliation glaucoma. J Neural Transm 114:571–575

    Article  PubMed  CAS  Google Scholar 

  24. Johnson TV, Fan S, Camras CB, Toris CB (2008) Aqueous humor dynamics in exfoliation syndrome. Arch Ophthalmol 126:914–920

    Article  PubMed  Google Scholar 

  25. Schlötzer-Schrehardt U, Naumann GOH (1995) Trabecular meshwork in pseudoexfoliation syndrome with and without open-angle glaucoma. A morphometric, ultrastructural study. Invest Ophthalmol Vis Sci 36:1750–1764

    PubMed  Google Scholar 

  26. Shuba L, Nicolela MT, Rafuse PE (2007) Correlation of capsular pseudoexfoliation material and iridocorneal angle pigment with the severity of pseudoexfoliation glaucoma. J Glaucoma 16:94–97

    Article  PubMed  Google Scholar 

  27. Yüksel N, Karabas VL, Arslan A et al (2001) Ocular hemodynamics in pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Ophthalmology 108:1043–1049

    Article  PubMed  Google Scholar 

  28. Schlötzer-Schrehardt U, Hammer CM, Krysta AW et al (2012) LOXL1 Deficiency in the lamina cribrosa as candidate susceptibility factor for a pseudoexfoliation-specific risk of glaucoma. Ophthalmology 119:1832–1843

    Article  PubMed  Google Scholar 

  29. Mitchell P, Wang JJ, Hourihan F (1999) The relationship between glaucoma and pseudoexfoliation: the Blue Mountains Eye Study. Arch Ophthalmol 117:1319–1324

    Article  PubMed  CAS  Google Scholar 

  30. Siam GA, Barros DS de, Gheith ME et al (2007) The amount of intraocular pressure rise during pharmacological pupillary dilatation is an indicator of the likelihood of future progression of glaucoma. Br J Ophthalmol 91:1170–1172

    Article  PubMed  Google Scholar 

  31. Naumann GOH (1997) Glaukome und Hypotonie-Syndrome (Pathologie des abnormen intraokularen Drucks) In: Naumann GOH (Hrsg) Pathologie des Auges, Bd 2, 2. Aufl. Springer, Berlin, Heidelberg, New York, S 1245–1371

  32. Chang S (2006) LXII Edward Jackson lecture: open angle glaucoma after vitrectomy. Am J Ophthalmol 141:1033–1043

    Article  PubMed  Google Scholar 

  33. Armaly MF (1965) Statistical attributes of the steroid hypertensive response in the clinically normal eye. I. The demonstration of three levels of response. Invest Ophthalmol 4:187–197

    PubMed  CAS  Google Scholar 

  34. Grodum K, Heijl A, Bengtsson B (2005) Risk of glaucoma in ocular hypertension with and without pseudoexfoliation. Ophthalmology 112:386–390

    Article  PubMed  Google Scholar 

  35. Ahrlich KG, De Moraeis CG, Teng CC et al (2010) Visual field progression differences between normal-tension and exfoliative high-tension glaucoma. Invest Ophthalmol Vis Sci 51:1458–1463

    Article  PubMed  Google Scholar 

  36. Landers J, Martin K, Sarkies N et al (2012) A twenty-year follow-up study of trabeculectomy: risk factors and outcomes. Ophthalmology 119:694–702

    Article  PubMed  Google Scholar 

  37. Konstas AGP, Mantziris DA, Stewart WC (1997b) Diurnal intraocular pressure in untreated exfoliation and primary open-angle glaucoma. Arch Ophthalmol 115:182–185

    Article  PubMed  CAS  Google Scholar 

  38. Gumus K, Bozkurt B, Sonmez B et al (2006) Diurnal variation of intraocular pressure and its correlation with retinal nerve fiber analysis in Turkish patients with exfoliation syndrome. Graefes Arch Clin Exp Ophthalmol 244:170–176

    Article  PubMed  Google Scholar 

  39. Konstas AG, Tsatsos I, Kardasopoulos A et al (1998) Preoperative features of patients with exfoliation glaucoma and primary open-angle glaucoma. The AHEPA study. Acta Ophthalmol Scand 76:208–212

    Article  PubMed  CAS  Google Scholar 

  40. Horn FK, Mardin CY, Laemmer R et al (2009) Correlation between local glaucomatous visual field defects and loss of nerve fiber layer thickness measured with polarimetry and spectral domain OCT. Invest Ophthalmol Vis Sci 50:1971–1977

    Article  PubMed  Google Scholar 

  41. Horn FK, Jonas JB, Korth M et al (1997) The full-field flicker test in early diagnosis of chronic open-angle glaucoma. Am J Ophthalmol 123:313–319

    PubMed  CAS  Google Scholar 

  42. Jünemann AG, Horn FK, Martus P, Korth M (2000) The full-field temporal contrast sensitivity test for glaucoma: influence of cataract. Graefes Arch Clin Exp Ophthalmol 238:427–432

    Article  PubMed  Google Scholar 

  43. Van Herick W, Shaffer RN, Schwartz A (1969) Estimation of width of angle of anterior chamber. Am J Ophthalmol 68:626–629

    Google Scholar 

  44. De Moraes CGV, Juthani VJ, Liebmann JM et al (2011) Risk factors for visual field progession in treated glaucoma. Arch Ophthalmol 129:562–568

    Google Scholar 

  45. Konstas AGP, Hollo G, Astakhov YS et al (2004) Factors associated with long-term progression or stability in exfoliation glaucoma. Arch Ophthalmol 122:29–33

    Article  PubMed  Google Scholar 

  46. Stewart WC, Konstas AG, Nelson LA, Kruft B (2008) Meta-analysis of 24-hour intraocular pressure studies evaluating the efficacy of glaucoma medicines. Ophthalmology 115:1117–1122

    Article  PubMed  Google Scholar 

  47. Erb C, Gast U, Schremmer D (2008) German register for glaucoma patients with dry eye. I. Basic outcome with respect to dry eye. Graefes Arch Clin Exp Ophthalmol 246:1593–1601

    Article  PubMed  Google Scholar 

  48. Yüksel N, Gök M, Altıntaş Ö, Çağlar Y (2011) Diurnal intraocular pressure efficacy of the timolol-brimonidine fixed combination and the timolol-dorzolamide fixed combination as a first choice therapy in patients with pseudoexfoliation glaucoma. Curr Eye Res 36:804–808

    Article  PubMed  Google Scholar 

  49. Parmaksiz S, Yuksel N, Karabas VL et al (2006) A comparison of travoprost, latanoprost, and the fixed combination of dorzolamide and timolol in patients with pseudoexfoliation glaucoma. Eur J Ophthalmol 16:73–80

    PubMed  CAS  Google Scholar 

  50. Naumann GO, Schlötzer-Schrehardt U (2000) Keratopathy in pseudoexfoliation syndrome as a cause of corneal endothelial decompensation: a clinicopathologic study. Ophthalmology 107:1111–1124

    Article  PubMed  CAS  Google Scholar 

  51. Erdoğan H, Arici DS, Toker MI et al (2006) Conjunctival impression cytology in pseudoexfoliative glaucoma and pseudoexfoliation syndrome. Clin Exp Ophthalmol 34:108–113

    Article  Google Scholar 

  52. Konstas AG, Topouzis F, Leliopoulou O et al (2006) 24-hour intraocular pressure control with maximum medical therapy compared with surgery in patients with advanced open-angle glaucoma. Ophthalmology 113:761–765

    Article  PubMed  Google Scholar 

  53. Goldenfeld M, Geyer O, Segev E et al (2011) Selective laser trabeculoplasty in uncontrolled pseudoexfoliation glaucoma. Ophthalmic Surg Lasers Imaging 42:390–393

    Article  PubMed  Google Scholar 

  54. George MK, Emerson JW, Cheema SA et al (2008) Evaluation of a modified protocol for selective laser trabeculoplasty. J Glaucoma 17:197–202

    Article  PubMed  Google Scholar 

  55. Tzimis V, Tze L, Ganesh J et al (2011) Laser trabeculoplasty: an investigation into factors that might influence outcomes. Can J Ophthalmol 46:305–309

    PubMed  Google Scholar 

  56. Nguyen NX, Küchle M, Martus P, Naumann GO (1999) Quantification of blood—aqueous barrier breakdown after trabeculectomy: pseudoexfoliation versus primary open-angle glaucoma. J Glaucoma 8:18–23

    Article  PubMed  CAS  Google Scholar 

  57. Marquardt D, Lieb WE, Grehn F (2004) Intensified postoperative care versus conventional follow-up: a retrospective long-term analysis of 177 trabeculectomies. Graefes Arch Clin Exp Ophthalmol 242:106–113

    Article  PubMed  Google Scholar 

  58. Park HY, Kim JH, Ahn MD, Park CK (2012) Level of vascular endothelial growth factor in tenon tissue and results of glaucoma surgery. Arch Ophthalmol 130:685–689

    Article  PubMed  Google Scholar 

  59. Borazan M, Karalezli A, Kucukerdonmez C et al (2010) Aqueous humor and plasma levels of vascular endothelial growth factor and nitric oxide in patients with pseudoexfoliation syndrome and pseudoexfoliation glaucoma. J Glaucoma 19:207–211

    Article  PubMed  Google Scholar 

  60. Mathew R, Barton K (2011) Anti-vascular endothelial growth factor therapy in glaucoma filtration surgery. Am J Ophthalmol 152:10–15

    Article  PubMed  CAS  Google Scholar 

  61. Drolsum L (2006) Longterm follow-up after deep sclerectomy in patients with pseudoexfoliative glaucoma. Acta Ophthalmol Scand 84:502–506

    Article  PubMed  Google Scholar 

  62. Wishart PK, Wishart MS, Choudhary A, Grierson I (2008) Long-term results of viscocanalostomy in pseudoexfoliative and primary open angle glaucoma. Clin Exp Ophthalmol 36:148–155

    Article  Google Scholar 

  63. Bull H, Wolff K von, Körber N, Tetz M (2011) Three-year canaloplasty outcomes for the treatment of open-angle glaucoma: European study results. Graefes Arch Clin Exp Ophthalmol 249:1537–1545

    Article  PubMed  Google Scholar 

  64. Lewis RA, Wolff K von, Tetz M et al (2011) Canaloplasty: three-year results of circumferential viscodilation and tensioning of Schlemm canal using a microcatheter to treat open-angle glaucoma. J Cataract Refract Surg 37:682–690

    Article  PubMed  Google Scholar 

  65. Grieshaber MC (2012) Ab externo Schlemm’s canal surgery: viscocanalostomy and canaloplasty. Dev Ophthalmol 50:109–124

    Article  PubMed  Google Scholar 

  66. Landa G, Pollack A, Rachmiel R et al (2005) Results of combined phacoemulsification and trabeculectomy with mitomycin C in pseudoexfoliation versus non-pseudoexfoliation glaucoma. Graefes Arch Clin Exp Ophthalmol 243:1236–1240

    Article  PubMed  CAS  Google Scholar 

  67. Damji KF, Konstas AG, Liebmann JM et al (2006) Intraocular pressure following phacoemulsification in patients with and without exfoliation syndrome: a 2 year prospective study. Br J Ophthalmol 90:1014–1018

    Article  PubMed  CAS  Google Scholar 

  68. Jacobi PC, Krieglstein GK (1995) Trabecular aspiration. A new surgical method for improving chamber angle facility in pseudoexfoliation glaucoma. Ophthalmologe 92:550–555

    PubMed  CAS  Google Scholar 

  69. Georgopoulos GT, Chalkiadakis J, Livir-Rallatos G et al (2000) Combined clear cornea phacoemulsification and trabecular aspiration in the treatment of pseudoexfoliative glaucoma associated with cataract. Graefes Arch Clin Exp Ophthalmol 238:816–821

    Article  PubMed  CAS  Google Scholar 

  70. Dinslage S, Rosentreter A, Schild AM et al (2012) Combined phacoemulsification with trabecular aspiration with differing outcomes in pseudoexfoliative glaucoma—a retrospective study. Klin Monatsbl Augenheilkd 229:641–644

    Article  PubMed  CAS  Google Scholar 

  71. Bleich S, Jünemann A, Ahsen N von et al (2002) Homocysteine and risk of open-angle glaucoma. J Neural Transm 109:1499–1504

    Article  PubMed  CAS  Google Scholar 

  72. Bleich S, Roedl J, Von Ahsen N et al (2004) Elevated homocysteine levels in aqueous humor of patients with pseudoexfoliation glaucoma. Am J Ophthalmol 138:162–164

    Article  PubMed  CAS  Google Scholar 

  73. Roedl JB, Bleich S, Reulbach U et al (2007) Homocysteine in tear fluid of patients with pseudoexfoliation glaucoma. J Glaucoma 16:234–239

    Article  PubMed  Google Scholar 

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  1. Klinik für Augenheilkunde, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 90154, Erlangen, Deutschland

    A.G.M. Jünemann

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Jünemann, A. Diagnose und Therapie des Pseudoexfoliationsglaukoms. Ophthalmologe 109, 962–975 (2012). https://doi.org/10.1007/s00347-012-2532-0

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