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Klin Monbl Augenheilkd 2015; 232(2): 162-168
DOI: 10.1055/s-0034-1396232
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Stellenwert der okulären Pulsamplitude beim Glaukom

Role of Ocular Pulse Amplitude in Glaucoma
J. P. E. Stürmer
1   Augenklinik, Kantonsspital, Winterthur, Schweiz
,
C. Kniestedt
2   Augenklinik, Universitätsspital Zürich, Schweiz
3   TAZZ, Talacker Augen Zentrum Zürich, Schweiz
› Author Affiliations
Further Information

Publication History

eingereicht 31 December 2014

akzeptiert 14 January 2015

Publication Date:
20 February 2015 (online)

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Zusammenfassung

Der Unterschied zwischen diastolischem und systolischem Augeninnendruck wird als okuläre Pulsamplitude (OPA) bezeichnet. Die okuläre Pulsamplitude entsteht durch den pulsatilen Blutfluss in der Choroidea und wird durch die Dynamik des kardiovaskulären Systems, die Rigidität der Gefäße sowie durch biometrische Faktoren des Auges beeinflusst. Die Abflussfazilität des Kammerwassers, die Höhe des Augendrucks selbst oder eine individuell unterschiedliche Elastizität der Bulbuswand wirken in bisher noch nicht restlos geklärtem Ausmaß auf die okuläre Pulsamplitude ein. Mit der dynamischen Konturtonometrie (Pascal®) lässt sich neben einer von Hornhautdicke und -radius weitgehend unabhängigen Druckmessung die okuläre Pulsamplitude einfach und schnell bestimmen. Die konturtonometrisch ermittelte OPA beträgt bei Augengesunden 1,2–4 mmHg. Bei OPA-Werten über 1,2 mmHg kann bei Augengesunden ein spontaner Puls der Zentralvene beobachtet werden. Während die OPA bei Patienten mit okulärer Hypertension druckabhängig i. d. R. höher ist als bei Augengesunden, ist sie bei Patienten mit klinisch manifestem Glaukom initial noch im Normbereich, bei fortschreitendem Gesichtsfeld- und Papillenschaden oder beim Glaukom mit vorrangiger Mangelperfusion am Sehnervenkopf zunehmend herabgesetzt. Ein Rückschluss von der Höhe der OPA auf die okuläre Durchblutung konnte wegen der zahlreichen Einflussfaktoren bis jetzt nicht im Einzelnen bewiesen werden. Neuere Untersuchungen mit einer Fourier-Spektralanalyse des okulären Pulses, und wenn möglich auch synchron des arteriellen Pulses, könnten in Zukunft einen vielversprechenden Ansatz zur Diskrimination zwischen Augengesunden und Glaukompatienten darstellen. Bei einer deutlich asymmetrischen OPA und gleichzeitig vorliegenden symmetrischen okulären Befunden sollte eine extraokuläre (vaskuläre) Ursache gesucht werden.

Abstract

The ocular pulse amplitude is defined as the difference between diastolic and systolic intraocular pressure. The ocular pulse is generated by the pulsatile ocular blood flow in the choroid. It is dependent on the dynamics of the cardiovascular system, the rigidity of the ocular vessels on one side and the biomechanical properties of the eye on the other side. In addition the influence of outflow facility of the aqueous humor, the level of the intraocular pressure itself and last but not least the rigidity of the sclera on the ocular pulse amplitude is until now not clear. Dynamic contour tonometry (Pascal®) does not only measure intraocular pressure almost independent of corneal thickness and curvature but also allows easy and fast measurement of ocular pulse amplitude on the slit lamp. The ocular pulse amplitude in healthy subjects is between 1.2 and 4 mmHg. If the ocular pulse amplitude is larger than 1.2 mmHg spontaneous pulsations of the central retinal vein are visible on fundoscopy. In patients with ocular hypertension the ocular pulse amplitude is larger than in normal subjects but this is mainly due to higher IOP levels. In patients with manifest open-angle glaucoma the ocular pulse amplitude stays initially within the normal range. In more advanced stages of the disease and especially in patients with ocular perfusion pressure dependent optic neuropathy the ocular pulse amplitude is gradually reduced. Due to the various factors influencing ocular pulse amplitude a direct correlation between reduced ocular pulse amplitude and reduced ocular perfusion pressure has not been established as yet. New approaches investigating the variations of the ocular pressure Fourier spectral analysis are promising, especially when simultaneous analysis of the arterial blood pressure is performed. These techniques may allow a fast and easy discrimination between healthy and glaucomatous patients in the near future. If ocular pulse amplitude exhibits a massive inter-ocular asymmetry in the presence of symmetrical ocular findings of extraocular vascular pathologies (i.e. carotid stenosis) are the most likely cause and therefore should be excluded.

Schlüsselwörter

okuläre Pulsamplitude - Pascal® - okuläre Hypertension - Glaukom - Niederdruckglaukom

Key words

ocular pulse amplitude - Pascal® - ocular hypertension - open-angle glaucoma - low-tension glaucoma
 

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