Download PDF
Klin Monbl Augenheilkd
DOI: 10.1055/a-1758-3486
CME-Fortbildung

Normaldruckglaukome

Normal Tension Glaucoma
Verena Prokosch
,
Sarah Barbara Zwingelberg
,
Karl Mercieca
› Further Information
Also available at
    Permissions and Reprints

Zusammenfassung

Das Normaldruckglaukom wird definiert wird als primär chronisches Offenwinkelglaukom, bei dem kein erhöhter Augeninnendruck vorliegt. Trotz normalem Augeninnendruck ist das primäre Ziel der Behandlung die Augeninnendrucksenkung, mit der es gelingen kann, die Erkrankung aufzuhalten. Dieser Artikel soll eine Übersicht über Epidemiologie, Ätiologie, Pathogenese, klinische Befunde sowie Therapien geben.

Abstract

Normal tension glaucoma (NTG) is a subvariant of primary open angle glaucoma (POAG) or a separate entity. NTG is defined as chronic open angle glaucoma without elevated intraocular pressure or normal intraocular pressure. Normal intraocular pressure is between 10 and 21 mmHg and is defined as two times the standard deviation of the mean intraocular pressure in the normal population. In addition to the absence of elevated intraocular pressure, all the classic symptoms of glaucoma are otherwise present. These include a conspicuous glaucomatous optic disc excavation, nerve fibre bundle defects, and corresponding visual field defects. Papillary rim haemorrhages are frequently found. The visual field defects in NDG are usually more central compared to POAG and are therefore described as more disturbing by the patient. The anterior chamber angle is open and there are no other changes suggestive of secondary glaucoma (pigment dispersion, pseudo-exfoliation). The exact pathophysiology of NDG is not well understood. Pathophysiologically, circulatory disturbances in the sense of arterial hypo- as well as hypertension may play an essential role or at least increase the susceptibility of the optic nerve to intraocular pressure fluctuations as well as blood pressure dips. Therefore, this requires not only a purely ophthalmologic but also interdisciplinary treatment of the patient with confirmed NDG. The primary goal of treatment is the reduction of intraocular pressure, which can stop the disease. This article gives an overview of epidemiology, aetiology, clinical findings and therapies.

Kernaussagen

  • Wichtigster Risikofaktor ist das Alter.

  • Gleich dem primären Offenwinkelglaukom handelt es sich beim Normaldruckglaukom um eine Optikusneuropathie.

  • Das Normaldruckglaukom ist eine Form des primären Offenwinkelglaukoms, bei der andere Risikofaktoren eine höhere Bedeutung haben als der Augeninnendruck selbst. Vaskuläre Faktoren spielen vermutlich eine Rolle. Die Unterteilung ist dabei willkürlich.

  • Der Kammerwinkel ist beim Normaldruckglaukom offen.

  • Das Normaldruckglaukom (NDG) verhält sich anders als primäre Offenwinkelglaukome (POWG), was die Art der Gesichtsfelddefekte und dessen Zusammenhang mit systemischen Faktoren wie dem Raynaud-Phänomen und der Migräne betrifft.

  • Auf eine dünne Hornhaut (auch bei Patienten nach refraktiven Laseroperationen) sollte geachtet werden, da die Druckmessungen zu niedrige IOD-Werten ausweisen können.

  • Eine 24-h-Blutdrucküberwachung ist vor allem bei Patienten sinnvoll, die eine blutdrucksenkende Behandlung erhalten, da diese angepasst werden kann, um nächtliche Schwankungen zu verringern.

  • Bei potenziellem Normaldruckglaukom sollte immer ein Neuro-Imaging und der Ausschluss anderer Optikusneuropathien in Betracht gezogen werden, insbesondere bei sehr asymmetrischer, atypischer oder einseitiger Erkrankung.

  • Trotz der vielen pathophysiologischen Theorien zur Ätiologie des NDG ist die Senkung des Augeninnendrucks nach wie vor die wichtigste Behandlung des NDG.

Schlüsselwörter

Normaldruckglaukom - neurodegenerative Erkrankungen - kardiovaskuläre Erkrankung - Optikusneuropathie

Key words

normal tension glaucoma - neurodegenerative disease,circulatory disorder - opticus neuropathy


Publication History

Article published online:
04 March 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 European Glaucoma Society. Terminology Guidelines Glaucoma. 5th ed. 2022. Im Internet (Stand: 26.01.2022): https://www.eugs.org/eng/guidelines.asp
  • 2 Grewe R. Zur Geschichte des Glaukoms. Klin Monbl Augenheilkd 1986; 188: 167-169
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 De Moraes CG. Natural history of normal-tension glaucoma with (very) low intraocular pressure. Ophthalmology 2019; 126: 1117-1118
    CrossrefPubMedSearch in Google Scholar
  • 4 Klein BE, Klein R, Sponsel WE. et al. Prevalence of glaucoma. The Beaver Dam Eye Study. Ophthalmology 1992; 99: 1499-1504
    CrossrefPubMedSearch in Google Scholar
  • 5 Cho HK, Kee C. Population-based glaucoma prevalence studies in Asians. Surv Ophthalmol 2014; 59: 434-447
    CrossrefPubMedSearch in Google Scholar
  • 6 Klein BE, Klein R, Sponsel WE. et al. Prevalence of glaucoma. The Beaver Dam Eye Study. Ophthalmology 1992; 99: 1499-1504
    CrossrefPubMedSearch in Google Scholar
  • 7 Grødum K, Heijl A, Bengtsson B. A comparison of glaucoma patients identified through mass screening and in routine clinical practice. Acta Ophthalmol Scand 2002; 80: 627-631
    CrossrefPubMedSearch in Google Scholar
  • 8 Dietlein TS, Jordan J, Dinslage S. et al. Profil einer universitären Glaukomsprechstunde. Objektive Behandlungsumstände und subjektive Einstellungen der Patienten. Ophthalmologe 2005; 102: 502-506
    CrossrefPubMedSearch in Google Scholar
  • 9 Vajaranant TS, Najak S, Wilensky JT. et al. Gender and glaucoma: what we know and what we need to know. Curr Opin Ophthalmol 2010; 21: 91-99
    CrossrefPubMedSearch in Google Scholar
  • 10 Dielemans I, Vingerling JR, Wolfs RC. et al. The prevalence of primary open-angle glaucoma in a population-based study in The Netherlands. The Rotterdam Study. Ophthalmology 1994; 101: 1851-1855
    CrossrefPubMedSearch in Google Scholar
  • 11 Bonomi L, Marchini G, Marraffa M. et al. Prevalence of glaucoma and intraocular pressure distribution in a defined population. The Egna-Neumarkt Study. Ophthalmology 1998; 105: 209-215
    CrossrefPubMedSearch in Google Scholar
  • 12 Rotchford AP, Johnson GJ. Glaucoma in Zulus: a population-based cross-sectional survey in a rural district in South Africa. Arch Ophthalmol 2002; 120: 471-478
    CrossrefPubMedSearch in Google Scholar
  • 13 Trivli A, Koliarakis I, Terzidou C. et al. Normal-tension glaucoma: Pathogenesis and genetics. Exp Ther Med 2019; 17: 563-574
    PubMedSearch in Google Scholar
  • 14 Sears NC, Boese EA, Miller MA. et al. Mendelian genes in primary open angle glaucoma. Exp Eye Res 2019; 186: 107702
    CrossrefPubMedSearch in Google Scholar
  • 15 Kim JA, Kim TW, Lee EJ. et al. Comparison of Lamina Cribrosa Morphology in Eyes with Ocular Hypertension and Normal-Tension Glaucoma. Invest Ophthalmol Vis Sci 2020; 61: 4
    CrossrefPubMedSearch in Google Scholar
  • 16 Flammer J, Orgül S, Costa VP. et al. The impact of ocular blood flow in glaucoma. Prog Retin Eye Res 2002; 21: 359-393
    CrossrefPubMedSearch in Google Scholar
  • 17 The AGIS Investigators. The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. Am J Ophthalmol 2000; 130: 429-440
    CrossrefPubMedSearch in Google Scholar
  • 18 Killer HE, Pircher A. Normal tension glaucoma: review of current understanding and mechanisms of the pathogenesis. Eye (Lond) 2018; 32: 924-930
    CrossrefPubMedSearch in Google Scholar
  • 19 Petrov SY. Sovremennyi vzglyad na glaukomu normalʼnogo davleniya [Modern view on normal-tension glaucoma]. Vestn Oftalmol 2020; 136: 57-64
    PubMedSearch in Google Scholar
  • 20 Sagiv O, Fishelson-Arev T, Buckman G. et al. Retinal nerve fibre layer thickness measurements by optical coherence tomography in patients with sleep apnoea syndrome. Clin Exp Ophthalmol 2014; 42: 132-138
    CrossrefPubMedSearch in Google Scholar
  • 21 Blumenthal EZ, Williams JM, Weinreb RN. et al. Reproducibility of nerve fiber layer thickness measurements by use of optical coherence tomography. Ophthalmology 2000; 107: 2278-2282
    CrossrefPubMedSearch in Google Scholar
  • 22 Garcia T, Tourbah A, Setrouk É. et al. Tomographie par cohérence optique (OCT) en neuro-ophtalmologie [Optical coherence tomography in neuro-ophthalmology]. J Fr Ophtalmol 2012; 35: 454-466
    CrossrefPubMedSearch in Google Scholar
  • 23 Jonas JB, Gusek GC, Naumann GO. Optic disc, cup and neuroretinal rim size, configuration and correlations in normal eyes. Invest Ophthalmol Vis Sci 1988; 29: 1151-1158
    PubMedSearch in Google Scholar
  • 24 Jonas JB, Budde WM, Lang P. Neuroretinal rim width ratios in morphological glaucoma diagnosis. Br J Ophthalmol 1998; 82: 1366-1371
    CrossrefPubMedSearch in Google Scholar
  • 25 Barleon L, Hoffmann EM, Berres M. et al. Comparison of dynamic contour tonometry and goldmann applanation tonometry in glaucoma patients and healthy subjects. Am J Ophthalmol 2006; 142: 583-590
    CrossrefPubMedSearch in Google Scholar
  • 26 Hoffmann EM, Lamparter J, Mirshahi A. et al. Distribution of central corneal thickness and its association with ocular parameters in a large central European cohort: the Gutenberg health study. PLoS One 2013; 8: e66158
    CrossrefPubMedSearch in Google Scholar
  • 27 Morad Y, Sharon E, Hefetz L, Nemet P. Corneal thickness and curvature in normal-tension glaucoma. Am J Ophthalmol 1998; 125: 164-168
    CrossrefPubMedSearch in Google Scholar
  • 28 Shetgar AC, Mulimani MB. The central corneal thickness in normal tension glaucoma, primary open angle glaucoma and ocular hypertension. J Clin Diagn Res 2013; 7: 1063-1067
    PubMedSearch in Google Scholar
  • 29 Jordan JF, Joergens S, Dinslage S. et al. Central and paracentral corneal pachymetry in patients with normal tension glaucoma and ocular hypertension. Graefes Arch Clin Exp Ophthalmol 2006; 244: 177-182
    CrossrefPubMedSearch in Google Scholar
  • 30 Ventura AC, Böhnke M, Mojon DS. Central corneal thickness measurements in patients with normal tension glaucoma, primary open angle glaucoma, pseudoexfoliation glaucoma, or ocular hypertension. Br J Ophthalmol 2001; 85: 792-795
    CrossrefPubMedSearch in Google Scholar
  • 31 Hong K, Wong IYH, Singh K. et al. Corneal Biomechanics Using a Scheimpflug-Based Noncontact Device in Normal-Tension Glaucoma and Healthy Controls. Asia Pac J Ophthalmol (Phila) 2019; 8: 22-29
    PubMedSearch in Google Scholar
  • 32 Grise-Dulac A, Saad A, Abitbol O. et al. Assessment of corneal biomechanical properties in normal tension glaucoma and comparison with open-angle glaucoma, ocular hypertension, and normal eyes. J Glaucoma 2012; 21: 486-489
    CrossrefPubMedSearch in Google Scholar
  • 33 Hoffmann EM, Prokosch-Willing V. Primäre Offenwinkelglaukome. Klin Monbl Augenheilkd 2017; 234: 1407-1422
    Thieme ConnectPubMedSearch in Google Scholar
  • 34 Kim KE, Park KH. Optic disc hemorrhage in glaucoma: pathophysiology and prognostic significance. Curr Opin Ophthalmol 2017; 28: 105-112
    CrossrefPubMedSearch in Google Scholar
  • 35 Kremme S, Selbach JM, Steuhl K-P. Das kardiovaskuläre Risikoprofil bei der Progression der Glaukomerkrankung. Dtsch Arztebl Ausg A 2000; 97: A-2241
    PubMedSearch in Google Scholar
  • 36 Chauhan BC, Mikelberg FS, Balaszi AG. et al. Canadian Glaucoma Study: 2. risk factors for the progression of open-angle glaucoma. Arch Ophthalmol 2008; 126: 1030-1036
    CrossrefPubMedSearch in Google Scholar
  • 37 Reznicek L, Lamparter J, Vogel M. et al. Flicker defined form perimetry in glaucoma suspects with normal achromatic visual fields. Curr Eye Res 2015; 40: 683-689
    CrossrefPubMedSearch in Google Scholar
  • 38 Leske MC, Heijl A, Hyman L. Early Manifest Glaucoma Trial: design and baseline data. Ophthalmology 1999; 106: 2144-2153
    CrossrefPubMedSearch in Google Scholar
  • 39 Leskea MC, Heijl A, Hyman L. et al. Factors for progression and glaucoma treatment: the Early Manifest Glaucoma Trial. Curr Opin Ophthalmol 2004; 15: 102-106
    CrossrefPubMedSearch in Google Scholar
  • 40 Caprioli J, Coleman AL. Intraocular pressure fluctuation a risk factor for visual field progression at low intraocular pressures in the advanced glaucoma intervention study. Ophthalmology 2008; 115: 1123-1129.e3
    CrossrefPubMedSearch in Google Scholar
  • 41 Rezapour J, Hoffmann EM. [The role of intraocular pressure fluctuation in the development and progression of glaucoma]. Klin Monbl Augenheilkd 2019; 236: 667-671
    Thieme ConnectPubMedSearch in Google Scholar
  • 42 Mozaffarieh M, Flammer J. New insights in the pathogenesis and treatment of normal tension glaucoma. Curr Opin Pharmacol 2013; 13: 43-49
    CrossrefPubMedSearch in Google Scholar
  • 43 Burr J, Azuara-Blanco A, Avenell A. et al. Medical versus surgical interventions for open angle glaucoma. Cochrane Database Syst Rev 2012; (09) CD004399
    PubMedSearch in Google Scholar
  • 44 Caprioli J, Coleman AL. Intraocular pressure fluctuation a risk factor for visual field progression at low intraocular pressures in the advanced glaucoma intervention study. Ophthalmology 2008; 115: 1123-1129.e3
    CrossrefPubMedSearch in Google Scholar
  • 45 Matlach J, Hipp M, Wagner M. et al. A comparative study of a modified filtering trabeculotomy and conventional trabeculectomy. Clin Ophthalmol 2015; 9: 483-492
    CrossrefPubMedSearch in Google Scholar
  • 46 Gedde SJ, Heuer DK, Parrish 2nd RK. Tube Versus Trabeculectomy Study Group. Review of results from the Tube Versus Trabeculectomy Study. Curr Opin Ophthalmol 2010; 21: 123-128
    CrossrefPubMedSearch in Google Scholar