Medikamentöse Therapie des Glaukoms

Zusammenfassung

Glaukom ist in Deutschland die zweithäufigste Ursache irreversibler Erblindungen. Es stehen verschiedene therapeutische Ansätze zur Verfügung. Neben der Verbesserung der vaskulären Perfusion und der Reduktion des oxidativen Stresses steht als zentrale Therapieoption nach wie vor die Senkung des Augeninnendrucks im Vordergrund. Dafür kommen verschiedene Wirkstoffklassen mit unterschiedlichem Wirkmechanismus und Nebenwirkungsprofil zur Anwendung.

Abstract

Glaucoma is the leading cause of irreversible blindness in Germany and in the world. Due to the multifactorial genesis of the disease, there are multiple therapeutic approaches for preventing its progression. The goal of the commonly used topical glaucoma medication is to reduce the intraocular pressure and therefore prevent further damage to the optic nerve. There are different medications of various pharmacological classes that are intended to reduce intraocular pressure, namely, β-adrenergic antagonists, adrenergic agonists, parasympathomimetic agents, prostaglandin analogues, carbonic anhydrase inhibitors, hyperosmotic agents, and the 2017 U. S. FDA approved Rho kinase inhibitor, Netarsudil.

After determining a patient centered target pressure, which depends upon various factors, an individual treatment regimen should be chosen with one or more agents. Although reducing the intraocular pressure remains the main therapeutic focus, there is increasing evidence indicating that oxidative stress also plays a key role in the pathogenesis of the primary open angle glaucoma. Therefore, direct and indirect neuroprotective agents like Magnesium, Coenzym Q10, Ginkgo biloba and others are getting more and more attention. While there is still a need for further clinical trials, these substances are getting more popular as an adjunct in glaucoma therapy.

Kernaussagen

• Die Senkung des Augeninnendrucks spielt in der medikamentösen Glaukomtherapie nach wie vor eine zentrale Rolle.

• Hierzu stehen folgende Substanzklassen mit unterschiedlichen Wirk- und Nebenwirkungsprofil zur Verfügung:

  • Betablocker,

  • Sympathomimetika,

  • Parasympathomimetika,

  • Prostaglandinderivate,

  • Karboanhydrasehemmer,

  • Osmotika,

  • Rho-Kinase-Inhibitoren.

• In Anbetracht der Lebenserwartung, des Stadiums der Erkrankung, der Progressionsrate, des Schädigungsdrucks, der Familienanamnese und des Vorliegens weiterer Risikofaktoren sollte ein individueller Zieldruck festgelegt werden.

• Der Nervenfaserverlust beim Glaukom ist ein multifaktorielles Geschehen.

• In Zukunft könnten direkte und indirekte neuroprotektive Maßnahmen zusätzlich zur Augendruckeinstellung einen größeren Stellenwert in der konservativen Glaukomtherapie einnehmen.

Schlüsselwörter

Glaukomtherapie - medikamentöse Drucksenkung - Rho-Kinase-Hemmer - Neuroprotektion

Key words

glaucoma - medical management - intraocular pressure - Rho kinase inhibitor - neuroprotection

Publication History

Article published online:
10 August 2020

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