Zusammenfassung
Die trabekuläre Abflussstörung beim Glaukom führt nicht nur zu einem Anstieg des Augeninnendruckniveaus, sondern bei der Majorität der Patienten auch zu einer Zunahme der Augeninnendruckschwankungen. Der hierdurch induzierte biomechanische Stress kann auf Dauer die Papille schädigen und zur typischen glaukomatösen Exkavation führen. Mit den Prostaglandinderivaten lassen sich beide Risikofaktoren positiv beeinflussen. Sie erhöhen den uveoskleralen Abfluss des Kammerwassers und steigern die trabekuläre Abflussfazilität sowie vermutlich auch die regulatorische Kapazität des Trabekelmaschenwerks. Dieser duale Wirkmechanismus scheint dafür verantwortlich zu sein, dass die Prostaglandinderivate sowohl den Augeneninnendruck, als auch die Schwankungsbreite stark reduzieren können - Resultat dürfte eine insgesamt verbesserte Kammerwasserdynamik sein. Pharmakologisch sinnvolle Kombinationspartner in der Therapie mit Prostaglandinderivaten sind daher Substanzen, die zusätzlich die Kammerwasserproduktion hemmen.
Abstract
In the glaucoma disease the disturbed trabecular outflow results not only in an increase in the intraocular pressure (IOP) level, but also in an increase in the intraocular pressure fluctuations in the majority of patients. This induces a biomechanical stress that may damage the optic nerve head over time and may result in the typical glaucomatous excavation. Prostaglandin analogues show positive effects on both risk factors. They enhance the uveoscleral outflow of the aqueous humour, improve the trabecular outflow facility and probably the regulatory capacity of the trabecular meshwork itself. This dual mechanism might explain the strong IOP-lowering efficacy of the prostaglandins and their additional property to reduce IOP fluctuations leading to a general improvement of the aqueous humour dynamics. Therefore, it makes sense pharmacologically to combine prostaglandins with those medications that also reduce aqueous humour production.
Schlüsselwörter
Kammerwasserdynamik - trabekulärer Abfluss - Prostaglandin-Therapie - Augeninnendruckschwankungen
Key words
Aqueous humor dynamics - trabecular outflow - prostaglandin therapy - intraocular pressure fluctuations
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Dr. Thomas Raber
Leiter Medizinisch-Wissenschaftliche Information, Alcon Pharma GmbH
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79108 Freiburg
Email: Thomas.Raber@Alconlabs.com
