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Klinische Papillenbeurteilung bei Glaukom

Clinical evaluation of the optic disc in glaucoma

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Zusammenfassung

Hintergrund

Die Glaukome sind durch eine charakteristische, progrediente Optikusneuropathie definiert, die gekennzeichnet ist durch morphologische Veränderungen des Sehnervenkopfs, der parapapillären Region und der Nervenfaserschicht.

Ziel der Arbeit

Typische glaukomatöse Veränderungen des Sehnervenkopfs, der parapapillären Region und der Nervenfaserschicht werden diskutiert und ihre ophthalmoskopische Diagnostik erläutert.

Methoden

Es erfolgte eine Literaturrecherche über PubMed.

Ergebnisse

Ein schrittweises Vorgehen zur qualitativen und quantitativen ophthalmoskopischen Papillenbeurteilung bezüglich glaukomatöser Veränderungen wird dargestellt.

Diskussion

Die systematische klinische, qualitative sowie quantitative Untersuchung der Papille im Hinblick auf glaukomatöse Veränderungen ist mit geringem Aufwand durchführbar und stellt die Grundlage der Diagnosestellung des Glaukoms und des therapeutischen Managements dar.

Abstract

Background

Glaucoma is defined as a progressive neuropathy of the optic nerve, characterized by specific changes of the optic disc, parapapillary region, and retinal nerve fiber layer.

Objectives

Characteristic glaucomatous changes of the optic disc, parapapillary region, and retinal nerve fiber layer are discussed and their ophthalmoscopic examination is described.

Materials and methods

A literature search in the PubMed database was conducted.

Results

A systematic step-by-step approach to a qualitative and quantitative ophthalmoscopic evaluation of the optic disc regarding glaucomatous damage is presented.

Conclusion

A systematic, clinical, qualitative, and quantitative assessment of the optic disc can be performed with little effort and forms the basis for diagnosis and treatment of glaucoma.

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Literatur

  1. Azuara-Blanco A, Katz LJ, Spaeth GL et al (2003) Clinical agreement among glaucoma experts in the detection of glaucomatous changes of the optic disk using simultaneous stereoscopic photographs. Am J Ophthalmol 136:949–950

    Article  PubMed  Google Scholar 

  2. Danesh-Meyer HV, Ku JYF, Papchenko TL et al (2006) Regional correlation of structure and function in glaucoma, using the disc damage likelihood scale, Heidelberg retina tomograph, and visual fields. Ophthalmology 113:603–611. doi:10.1016/j.ophtha.2005.10.055

    Article  PubMed  Google Scholar 

  3. Drance SM, Begg IS (1970) Sector haemorrhage – a probable acute ischaemic disc change in chronic simple glaucoma. Can J Ophthalmol 5:137–141

    CAS  PubMed  Google Scholar 

  4. Gracitelli CPB, Tatham AJ, Zangwill LM et al (2014) Estimated rates of retinal ganglion cell loss in glaucomatous eyes with and without optic disc hemorrhages. PLoS ONE 9:e105611. doi:10.1371/journal.pone.0105611

    Article  PubMed  PubMed Central  Google Scholar 

  5. Grieshaber MC, Terhorst T, Flammer J (2006) The pathogenesis of optic disc splinter haemorrhages: a new hypothesis. Acta Ophthalmol Scand 84:62–68. doi:10.1111/j.1600-0420.2005.00590.x

    Article  PubMed  Google Scholar 

  6. Gutman I, Melamed S, Ashkenazi I, Blumenthal M (1993) Optic nerve compression by carotid arteries in low-tension glaucoma. Graefes Arch Clin Exp Ophthalmol 231:711–717

    Article  CAS  PubMed  Google Scholar 

  7. Harizman N, Oliveira C, Chiang A et al (2006) The ISNT rule and differentiation of normal from glaucomatous eyes. Arch Ophthalmol 124:1579–1583. doi:10.1001/archopht.124.11.1579

    Article  PubMed  Google Scholar 

  8. Healey P (2011) Optic disc haemorrhage: the more we look the more we find. Clin Experiment Ophthalmol 39:485–486. doi:10.1111/j.1442-9071.2011.02648.x

    Article  PubMed  Google Scholar 

  9. Healey PR, Mitchell P, Smith W, Wang JJ (1998) Optic disc hemorrhages in a population with and without signs of glaucoma. Ophthalmology 105:216–223

    Article  CAS  PubMed  Google Scholar 

  10. Henderer JD, Liu C, Kesen M et al (2003) Reliability of the disk damage likelihood scale. Am J Ophthalmol 135:44–48

    Article  PubMed  Google Scholar 

  11. Jonas JB, Nguyen XN, Gusek GC, Naumann GO (1989) Parapapillary chorioretinal atrophy in normal and glaucoma eyes. I. morphometric data. Invest Ophthalmol Vis Sci 30:908–918

    CAS  PubMed  Google Scholar 

  12. Jonas JB, Mardin CY, Schlötzer-Schrehardt U, Naumann GO (1991) Morphometry of the human lamina cribrosa surface. Invest Ophthalmol Vis Sci 32:401–405

    CAS  PubMed  Google Scholar 

  13. Kalenak JW, Kosmorsky GS, Hassenbusch SJ (1992) Compression of the intracranial optic nerve mimicking unilateral normal-pressure glaucoma. J Clin Neuroophthalmol 12:230–235 (discussion 236–7)

    CAS  PubMed  Google Scholar 

  14. Lee EJ, Kim T‑W, Kim M et al (2014) Recent structural alteration of the peripheral lamina cribrosa near the location of disc hemorrhage in glaucoma. Invest Ophthalmol Vis Sci 55:2805–2815. doi:10.1167/iovs.13–12742

    Article  PubMed  Google Scholar 

  15. 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 121:48–56

    Article  PubMed  Google Scholar 

  16. Mardin CY (2012) The most important signs of a glaucomatous disc. Klin Monbl Augenheilkd 229:112–118. doi:10.1055/s-0031-1299127

    Article  CAS  PubMed  Google Scholar 

  17. Mardin CY, Horn F, Viestenz A et al (2006) Healthy optic discs with large cups – a diagnostic challenge in glaucoma. Klin Monbl Augenheilkd 223:308–314. doi:10.1055/s-2005-858855

    Article  CAS  PubMed  Google Scholar 

  18. Park HYL, Jeong HJ, Kim YH, Park CK (2015) Optic disc hemorrhage is related to various hemodynamic findings by disc angiography. PLoS ONE 10:e0120000. doi:10.1371/journal.pone.0120000

    Article  PubMed  PubMed Central  Google Scholar 

  19. Reus NJ, de Graaf M, Lemij HG (2007) Accuracy of GDx VCC, HRT I, and clinical assessment of stereoscopic optic nerve head photographs for diagnosing glaucoma. Br J Ophthalmol 91:313–318. doi:10.1136/bjo.2006.096586

    Article  PubMed  Google Scholar 

  20. Reus NJ, Lemij HG, Garway-Heath DF et al (2010) Clinical assessment of stereoscopic optic disc photographs for glaucoma: the European optic disc assessment trial. Ophthalmology 117:717–723. doi:10.1016/j.ophtha.2009.09.026

    Article  PubMed  Google Scholar 

  21. Society EG Terminology and guidelines for glaucoma, 4 Aufl. SvetPrint d.o.o

  22. Spaeth GL (2005) The Disc Damage Likelihood Scale. Glaucoma Today :19–21

  23. Spaeth GL, Lopes JF, Junk AK et al (2006) Systems for staging the amount of optic nerve damage in glaucoma: a critical review and new material. Surv Ophthalmol 51:293–315. doi:10.1016/j.survophthal.2006.04.008

    Article  PubMed  Google Scholar 

  24. Zangalli C, Gupta SR, Spaeth GL (2011) The disc as the basis of treatment for glaucoma. Saudi J Ophthalmol 25:381–387. doi:10.1016/j.sjopt.2011.07.003

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Augenheilkunde, Klinikum, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    R. Greslechner & D. Spiegel

  2. Augenzentrum München Süd, München, Deutschland

    D. Spiegel

Authors
  1. R. Greslechner
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  2. D. Spiegel
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Correspondence to R. Greslechner.

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Interessenkonflikt

R. Greslechner und D. Spiegel geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Greslechner, R., Spiegel, D. Klinische Papillenbeurteilung bei Glaukom. Ophthalmologe 113, 816–823 (2016). https://doi.org/10.1007/s00347-016-0331-8

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  • DOI: https://doi.org/10.1007/s00347-016-0331-8

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