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Augenheilkunde up2date 2022; 12(01): 73-88
DOI: 10.1055/a-1262-3134
Glaukom

Normaldruckglaukome

Normal Tension Glaucoma
Verena Prokosch
,
Sarah Barbara Zwingelberg
,
Karl Mercieca
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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

 

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