Zusammenfassung
Bei sekundären Winkelblockglaukomen liegt mindestens eine identifizierbare
Ursache für den Winkelblock und die Obstruktion des Kammerwasserabflusses vor.
Diese spezielle Unterform des Glaukoms ist eine besonders heterogene Gruppe an
Erkrankungen bzw. Ursachen, die sich in ihrer Auswirkung auf den
Kammerwasserfluss und in ihrer Behandlung deutlich unterscheiden. Dieser Beitrag
gibt eine Übersicht über die verschiedenen Formen des sekundären
Winkelblockglaukoms und zeigt die Ansatzpunkte für eine zielgerichtete Therapie
auf.
Abstract
Secondary angle closure glaucoma is a very heterogeneous subtype of glaucoma with
a variety of possible causes leading to a blockade of the regular aqueous humour
flow or outflow. A distinction is made between secondary pupillary block, angle
closure with “pulling” or angle closure with “pushing” mechanisms. For each of
these three subgroups, there are different causes, which in turn require
individual therapy. Treatment of the underlying cause should always take
priority whenever possible. Reduction of the intraocular pressure is often a
symptomatic therapy with surgical, pressure lowering procedures showing a
limited success rate in many forms of secondary angle closure glaucoma. This
article intends to provide an overview of the different causes of secondary
angle closure, diagnostic approaches and targeted therapies of exemplary causes
of each subgroup.
From the group of secondary pupillary block, mechanical causes, iris bombé, and
intraoperative air or oil input are addressed, from the group of “pulling”
causes, angle neovascularization, post-inflammatory angle changes, and
iridocorneal endothelial syndrome and for the group of “pushing” mechanisms, gas
endotamponade, retroiridal neoplasms and aqueous misdirection syndrome.
While secondary angle closure is one of the most challenging glaucoma subgroups
for treatment it is crucial to know the different subgroups and their
development to choose the right treatment.
Schlüsselwörter
sekundärer Winkelblock - Glaukom - Pupillarblock
Key words
secondary angle closure - glaucoma - pupillary block
