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Klin Monbl Augenheilkd 2016; 233(07): 847-855
DOI: 10.1055/s-0042-101552
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Aktueller Stellenwert der Druckmessung: Messverfahren und Fehlerquellen

Value of Pressure Measurements: Methods and Sources of Errors
F. Rüfer
Nordblick Augenklinik Bellevue, Nordblick GmbH, Kiel
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Publication History

eingereicht 09 November 2015

akzeptiert 03 December 2015

Publication Date:
30 April 2016 (online)

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Erratum: Aktueller Stellenwert der Druckmessung: Messverfahren und FehlerquellenKlin Monbl Augenheilkd 2016; 233(07): 855-855
DOI: 10.1055/s-0036-1585124

Zusammenfassung

Die Tonometrie ist für die Glaukomdiagnostik nach wie vor ein unverzichtbarer Bestandteil. Funktionelle und morphologische Untersuchungen können sehr detailliert über das Ausmaß einer glaukomatösen Schädigung Auskunft geben. Ihre Stärken liegen in der Früherkennung eines Glaukomschadens und bei manifesten Schäden in der Abschätzung der Progressionsrate durch Verlaufsuntersuchungen. Im Gegensatz dazu sind die Tonometrieverfahren weitaus unperfekter, weniger sensitiv, und sie geben keinerlei Auskunft über das Ausmaß eines Glaukomschadens. Aber: Sie liefern oft den ersten Hinweis darauf, dass überhaupt ein Glaukom vorliegen könnte, und sie sind der entscheidende Parameter, wenn es darum geht, die Dosierung einer operativen oder medikamentösen drucksenkenden Therapie zu kontrollieren, weil die Senkung des intraokularen Druckes (IOD) trotz des Wissens um zahlreiche weitere Glaukomrisikofaktoren immer noch der verbreitetste Therapieansatz ist. Dass die IOD-Senkung bei vielen Glaukomformen eine wirksame Therapie darstellt, muss an dieser Stelle nicht hinterfragt werden und wurde in zahlreichen großen epidemiologischen Studien belegt. Die Tonometrieverfahren haben sich in den letzten Jahren weiter verfeinert. Neben der weit verbreiteten Goldmann-Applanationstonometrie (GAT) und der Luftstoßtonometrie gibt es einige Anwendungsbereiche, für die sich auch die seltener verwendeten Tonometrieverfahren empfehlen. Darüber hinaus gibt es Ansätze für quasikontinuierliche Druckmessungen, welche die derzeit gängige Praxis der punktuellen IOD-Bestimmung in Zukunft überholen könnten. Es gibt eine Vielzahl von Fallstricken in der klinischen Praxis, die bei den Tonometrieverfahren zu Fehlinterpretationen und zu therapeutischen Fehlentscheidungen führen können, sodass es weiterhin wichtig erscheint, immer wieder darauf hinzuweisen.

Abstract

Tonometry is still an essential component of diagnostic testing in glaucoma. Functional and morphological investigations can provide very detailed information about the extent of glaucomatous damage. They are useful in the early detection of glaucoma damage; when damage is manifest, they are useful in estimating the rate of progression in follow-up studies. In contrast, tonometric procedures are much less perfect and sensitive and provide no information at all about the extent of glaucoma damage. However, they often provide the first evidence that glaucoma may be present at all and they are the decisive parameter in controlling surgical or medical treatment to reduce pressure, as the reduction in intraocular pressure (IOD) is still the most common approach in treating glaucoma – in spite of our awareness of numerous other risk factors for glaucoma. There is no reason to doubt that reducing IOD is an effective therapy in many forms of glaucoma, as this has been demonstrated in numerous large epidemiological studies. Tonometric procedures have become more precise in recent years. Goldmann applanation tonometry (GAT) and pneumatonometry are widely used. There are also some areas for which the rarer forms of tonometry can be recommended. Procedures for quasi-continuous pressure measurements and, in the future, these may replace the current approach of measuring IOD at discrete time points. There are a variety of snares in clinical practice, which may lead to misinterpretation and wrong therapeutic decisions, so that these must be repeatedly emphasised.

Schlüsselwörter

Glaukom - Tonometrie - Methoden - kontinuierliche Druckmessung - Fehler

Key words

glaucoma - tonometry - methods - continuous pressure measurement - errors
 

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