Diagnostik und Therapie des Normaldruckglaukoms

D. Baleanu; G. Michelson

doi:10.1055/s-2005-858741

Klinische Monatsblätter für Augenheilkunde, Table of Contents

Klin Monbl Augenheilkd 2005; 222(10): 760-771
DOI: 10.1055/s-2005-858741

Übersicht

Diagnostik und Therapie des Normaldruckglaukoms

Diagnostics and Therapy for Normal Tension GlaucomaD. Baleanu¹ , G. Michelson¹

¹Universitäts-Augenklinik Erlangen

Abstract

Zusammenfassung

Gepoolte Daten der Studien „The Baltimore Eye Survey”, „The Blue Mountains Eye Study”, „The Beaver Dam Eye Study”, „The Rotterdam Study” und „The Melbourne VIP” ergeben eine stark altersabhängige Prävalenz von Offenwinkelglaukomen. Bis zu einem Alter von 60 Jahren beträgt die Häufigkeit von Offenwinkelglaukomen ca. 1 %. Ab dem 60. Lebensjahr steigt die Prävalenz exponenziell an. Personen in der 8. Lebensdekade weisen eine Prävalenz von ca. 5 % auf. 30 - 50 % dieser Patienten haben normale Augeninnendruckwerte. Die Diagnostik und Therapie von Offenwinkelglaukomen mit normalen Augeninnendruckwerten ist komplex und häufig fächerübergreifend. Als nachweisbare kausale Faktoren für die Entwicklung einer glaukomatösen Opticusatrophie bei NDG gelten: relativ erhöhter IOP, höheres Alter, zu niedriger (0 - 10 %) oder zu starker nächtlicher Blutdruckabfall (> 20 %), das Vorliegen einer „Small Vessel Disease” mit kardiovaskulären Erkrankungen und zerebralen mikrovaskulären Gliosen (WML), erniedrigter Randsaumblutfluss, verstärkter morgendlicher Abfall des Randsaumblutflusses, zerebrale Regulationsstörungen und ein erhöhtes Vorkommen des Epsilon4-Allels des Apolipoprotein-E-Gens. Es werden klinische Pfade zur Diagnostik und Therapie dieser Glaukomform dargestellt.

Abstract

Pooled data from “The Baltimore Eye Survey”, “The Blue Mountains Eye Study”, “The Beaver Dam Eye Study”, “The Rotterdam Study” and “The Melbourne VIP” showed a strong age-dependent prevalence of open angle glaucoma. Patients younger than 60 years have a prevalence of open angle glaucoma of less than 1 %. Beginning with the age of 60 the prevalence increases exponentially. The prevalence of open angle glaucoma in persons in the 8^th age decade reaches up to 5 %. Among these patients, 30 - 50 % have normal intraocular pressure. The diagnostics and therapy for open angle glaucoma with normal intraocular pressure (IOP), also called normal tension glaucoma, is a complex and often interdisciplinary challenge. Established causative factors for developing a glaucomatous optic nerve atrophy in normal tension glaucoma are: relatively increased IOP, older age, non-dippers (0 - 10 %) or extreme dippers (> 20 %) concerning nocturnal arterial blood pressure drop, small vessel disease with cardiovascular disease and cerebral microgliosis (white matter lesions), decreased blood flow in the optic nerve head, extreme dip of the optic nerve head blood flow in the morning, cerebral blood flow dysregulation and the epsilon4-allele polymorphism of the apolipoprotein E-gene. Clinical pathways are presented for the diagnostics and therapy for normal tension glaucoma.

Schlüsselwörter

Glaukom - Normaldruckglaukom - primäres Offenwinkelglaukom - neurovaskuläre Kopplung - White Matter Lesions - Endothelzelldysfunktion

Key words

Glaucoma - normal tension glaucoma - primary open angle glaucoma - neurovascular coupling - white matter lesions - endothelial dysfunction

Full Text

References

Literatur

1 Adult Treatment Panel III . Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP). JAMA. 2001; 285 (19) 2486-2497
2 Altan-Yaycioglu R, Turder G, Akdol S. et al . The effects of beta-blockers os ocular blood flow in patients with primary open angle glaucoma: a color doppler imaging study. Eur J Ophthalmol. 2001; 11 37-46
3 Anderson D R, Drance S M, Schulzer M. et al . Factors that predict the benefit of lowering intraocular pressure in normal tension glaucoma. Am J Ophthalmol. 2003; 136 (5) 820-829
4 Bartlett H, Eperjesi F. An ideal ocular nutritional supplement?. Ophthal Physiol Opt. 2004; 24 339-349
5 Berendes R. Pulswellenanalyse der okulären Mikro- und Makrozirkulation: physiologische Grundlagen und Pathologie beim Glaukom. Erlangen, Nürnberg; Med. Dissertation 1998: 11-124
6 Bleich S, Junemann A, von Ahsen N. et al . Homocysteine and risk of open-angle glaucoma. J Neural Transm. 2002; 109 (12) 1499-1504
7 Boles-Carenini A, Sibour G, Carenini B B. Differences in the longtermeffect of timolol and betaxolol on the pulsatile ocular blood flow. Surv Ophthalmol. 1994; 38 (Suppl) 118-124
8 Bonomi L, Marchini G, Maraffa M. Vascular risk factors for primary open angle glaucoma. The Egna-Neumarkt Study. Ophthalmology. 2000; 107 1287-1293
9 Bonomi L, Marchini G, Marraffa M. et al . Prevalence of glaucoma and intraocular pressure distribution in a defined population. The Egna-Neumarkt Study. Ophthalmology. 1998; 105 (2) 209-215
10 Buckley C, Hadoke P. Systemic vascular endothelial cell dysfunction in NPG. Br J Ophthalmol. 2002; 86 (2) 227-232
11 Budde W M. Heredity in primary open-angle glaucoma. Curr Opin Ophthalmol. 2000; 11 101-106
12 Cadelo M, Inzitari D, Pracucci G. et al . Predictors of leukoaraiosis in elderly neurological patients. Cerebrovasc Dis. 1991; 1 345-351
13 Caprioli J, Spaeth G L. Comparison of the optic nerve head in high- and low-tension glaucoma. Arch Ophthalmol. 1985; 103 1145-1149
14 Chauhan B C, Drance S M, Douglas G. et al . Visual field damage in normal tension and high tension glaucoma. Am J Ophthalmol. 1989; 108 636-642
15 Chung H S, Harris A, Kagemann L. et al . Peripapillary retinal blood flow in normal tension glaucoma. Br J Ophthalmol. 1999; 83 466-469
16 Collaborative Normal-Tension Glaucoma Study Group . Comparison of Glaucomatous Progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. Am J Ophthalmol. 1998; 126 487-497
17 Comoglu S, Yarangumeli A, Koz O G. et al . Glaucomatous visual field defects in patients with migraine. J Neurol. 2003; 250 201-206
18 Cursiefen C, Wisse M, Cursiefen S. et al . Migraine and tension headache in high-pressure and normal-pressure glaucoma. Am J Ophthalmol. 2000; 129 102-104
19 de Leeuw F E, Richard F, de Groot J. et al . Interaction between Hypertension, apoE, and cerebral white matter lesions. Stroke. 2004; 35 1057-1062
20 Delles C, Michelson G, Harazny J. et al . Impaired endothelial function of the retinal vasculature in hypertensive patients. Stroke. 2004; 35 (6) 1289-1293
21 Dielemans I, de Jong P T, Stolk R. et al . Primary openangle glaucoma, intraocular pressure, and diabetes mellitus in the general elderly population. The Rotterdam Study. Ophthalmology. 1996; 103 1271-1275
22 Dietlein T S, Jordan J, Jacobi P C. et al . Profil einer universitären Glaukomsprechstunde. Ophthalmologe. 2005; 102 502-506
23 Dorner G T, Garhofer G, Huemer K H. et al . Hyperglycemia affects flicker-induced vasodilatation in the retina of healthy subjects. Vision Research. 2003; 43 (13) 1495-1500
24 Doshi S N, Goodfellow J, Lewis M J. et al . Homocysteine and endothelial function. Cardiovasc Res. 1999; 42 578-582
25 Drance S, Anderson D R, Schulzer M. Risk factors for progression of visual field abnormalities in normal-tension glaucoma. Am J Ophthalmol. 2001; 131 699-708
26 European Glaucoma Society .Terminology and Guidelines for Glaucoma (IInd Edition). Editrice DOGMA s.r.l. 2003 Ch 2 - 5
27 Fassbender K, Mielke O, Bertsch T. et al . Homocysteine in cerebral macroangiography and microangiopathy. Lancet. 1999; 353 1586-1593
28 Flammer J, Orgul S, Costa V P. et al . The impact of ocular blood flow in glaucoma. Prog Retin Eye Res. 2002; 21 (4) 359-393
29 Flammer J, Haefliger I O, Orgul S. et al . Vascular dysregulation: a principal risk factor for glaucomatous damage?. J Glaucoma. 1999; 8 212-219
30 Flammer J, Pache M, Resink T. Vasospasm, its role in the pathogenesis of diseases with particular reference to the eye. Prog Retin Eye Res. 2001; 20 319-349
31 Fontana L, Poinoosawmy D, Bunce C V. et al . Pulsatile ocular blood flow investigation in asymmetric normal tension glaucoma and normal subjects. Br J Ophthalmol. 1998; 82 731-736
32 Fuse N, Takahashi K, Akiyama H. et al . Molecular genetic analysis of optineurin gene for primary open-angle and normal tension glaucoma in the Japanese population. J Glaucoma. 2004; 13 299-303
33 Gandolfi S A, Sangermani C, Cimino L. et al . Is there a non-IOP-related effect of brimonidine on visual field progression in human glaucoma?. ARVO Meeting. 2004; Poster 2298
34 Garhofer G, Zawinka C, Resch H. et al . Response of retinal vessel diameters to flicker stimulation in patients with early open angle glaucoma. J Glaucoma. 2004; 13 (4) 340-344
35 Geijssen H C. Studies on normal pressure glaucoma. Amsterdam; Kugler 1991 1: 1
36 Ghiadoni L, Virdis A, Magagna A. et al . Effect of the angiotensin II type 1 receptor blocker candesartan on endothelial function in patients with essential hypertension. Hypertension. 2000; 35 501-506
37 Graham S L, Drance S M, Wijsman K. et al . Ambulatory blood pressure monitoring in glaucoma patients: The nocturnal dip. Ophthalmology. 1995 ; 61-69
38 Grodum K, Heijl A, Bengtsson B. A comparison of glaucoma patients identified through mass screening and in routine clinical practice. Acta Ophthalmol Scand. 2002; 80 (6) 627-631
39 Groh M J, Michelson G, Harazny J. et al . Changes in retinal blood flow by topical administration of 0.1 % dipivefrin. Ophthalmologe. 1999; 96 (11) 706-710
40 Grus F H, Joachim S C, Hoffmann E M. et al . Complex autoantibody repertoires in patients with glaucoma. Mol Vis. 2004; 25 (10) 132-137
41 Harazny J, Michelson G. Ocular Cold Pressor Test - New diagnostic test in patients with normal tension glaucoma. Klin Monatsbl Augenheilkd 1999; Annual Meeting of the Bavarian Ophthalmology Society, Erlangen 26 - 27.11 1999 215 (Suppl 11): 8
42 Harazny J. Zirkulation des Auges bei Patienten mit Normaldruckglaukomen. Erlangen, Nürnberg; Inauguraldissertation 2001
43 Harju M, Vesti E. Blood flow of the optic nerve head and peripapillary retina in exfoliation syndrome with unilateral glaucoma or ocular hypertension. Graefes Arch Clin Exp Ophthalmol. 2001; 239 271-277
44 Harris A, Arend O, Chung H S. et al . A comparative study of betaxolol and dorzolamide effect on ocular circulation in normal-tension glaucoma pacients. Ophthalmology. 2000; 107 430-434
45 Hassan A, Hunt B J, O’Sullivan M. et al . Homocysteine is a risk factor for cerebral small vessel disease, acting via endothelial dysfunction. Brain. 2004; 127 (1) 212-219
46 Hayreh S S. The role of age and cardiovascular disease in glaucomatous optic neuropathy. Surv Ophthalmol. 1999; 43 (Suppl 1) S27-S42
47 Hayreh S S, Zimmerman M B, Podhajsky P. et al . Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders. Am J Ophthalmol. 1994; 117 603-624
48 Henon H, Vroylandt P, Durieu I. et al . Leukoaraiosis More Than Dementia Is a Predictor of Stroke Recurrence. Stroke. 2003; 34 2935-2940
49 Henry E, Newby D E, Webb D J. et al . Peripheral endothelial dysfunction in normal pressure glaucoma. Invest Ophthalmol Vis Sci. 1999; 40 1710-1714
50 Husson I, Mesples B, Bac P. et al . Melatoninergic neuroprotection of the murine periventricular white matter against neonatal excitotoxic challenge. Ann Neurol. 2002; 51 (1) 82-92
51 Inzitari D, Giordano G P, Ancona A L. et al . Leukoaraiosis, intracerebral hemorrhage, and arterial hypertension. Stroke. 1990; 21 1419-1423
52 Javitt J C, Spaeth G L, Katz L J. et al . Acquired pits of the optic nerve. Increased prevalence in patients with low-tension glaucoma. Ophthalmology. 1990; 97 1038-1043
53 John S, Schneider M P, Delles C. et al . Lipidindependent effects of statins on endothelial function and bioavailability of nitric oxide in hypercholesterinemic patients. Am Heart J. 2005; 149 (3) 473
54 Kaiser H J, Flammer J. Systemic hypotension: risk factor for glaucomatous damage?. Ophthalmologica. 1991; 203 105-108
55 Kaiser H J, Flammer J, Graf T. et al . Systemic blood pressure in glaucoma patients. Graefes Arch Clin Exp Ophthalmol. 1993; 231 677-680
56 Kamal D, Hitchings R. Normal tension glaucoma - a practical approach. Br J Ophthalmol. 1998; 82 (7) 835-840
57 Kang J H, Pasquale L R, Wilett W C. et al . Dietary fat consumption and primary open-angle glaucoma. Am J Clin Nutr. 2004; 79 755-764
58 Kario K, Matsuo T, Kobayashi H. et al . Nocturnal fall of blood pressure and silent cerebrovascular damage in elderly hypertensive patients: advanced silent cerebro-vascular damage in extreme dippers. Hypertension. 1996; 27 130-135
59 Kario K, Montai K, Mitsuhashi T. et al . Autonomic nervous system dysfunction in elderly hypertensive patients with abnormal diurnal blood pressure variation: relation to silent cerebrovascular disease. Hypertension. 1997; 30 1504-1510
60 Kitasawa Y, Shirai H, Go F J. The Effect of Ca2 +-antagonists on visual field in low-tension glaucoma. Graefes Arch Clin Exp Ophthalmol. 1989; 227 408-412
61 Klein B EK, Klein R, Sponsel W E. et al . Prevalence of glaucoma. The Beaver Dam Eye Study. Ophthalmology. 1992; 99 1499-1504
62 Klein B E, Klein R, Jensen S C. Open-angle glaucoma and older-onset diabetes. The Beaver Dam Eye Study. Ophthalmology. 1994; 101 1173-1177
63 Klingbeil A U, John S, Schneider M P. et al . Effect of AT1 receptor blockade on endothelial function in essential hypertension. Am J Hypertens. 2003; 16 123-128
64 Koseki N, Araie M, Yamagami J. et al . Effects of oral brovincamine on visual field damage in patients with normal-tension glaucoma with low-normal intraocular pressure. J Glaucoma. 1999; 8 (2) 117-123
65 Kruit M C, van Buchem M A, Hofman P A. et al . Migraine as a risk factor for subclinical brain lesions. JAMA. 2004; 29 (4) 427-434
66 Leblhuber F, Walli J, Artner-Dworzak E. et al . Hyperhomocysteinemia in dementia. J Neural Transm. 2000; 107 1469-1474
67 Lebuisson D A, Leroy L, Rigal G. Treatment of senile macular degeneration with Ginkgo biloba extract - preliminary double-blind, drug vs placebo study. Presse Med. 1986; 15 1556-1558
68 Levene R. Low tension glaucoma: a critical review and new material. Surv Ophthalmol. 1980; 61 621-664
69 Longstreth W T Jr, Manolio T A, Arnold A. et al for the Cardiovascular Health Study Collaborative Research Group. . Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people. The Cardiovascular Health Study. Stroke. 1996; 27 1274-1282
70 McGwin G Jr, McNeal S, Owsley C. et al . Statins and other cholesterol-lowering medications and the presence of glaucoma. Arch Ophthalmol. 2004; 122 (6) 822-826
71 Michalk F, Michelson G, Harazny J. et al . Single-dose nimodipine normalizes impaired retinal circulation in normal tension glaucoma. J Glaucoma. 2004; 13 (2) 158-162
72 Michelson G, Schmauss B. Two dimensional mapping of the perfusion of the retina and optic nerve head. Br J Ophthalmol. 1995; 79 1126-1132
73 Michelson G, Welzenbach J, Pal I. et al . Automatic full field analysis of perfusion images gained by scanning laser Doppler flowmetry. Br J Ophthalmol. 1998; 82 (11) 1294-1300
74 Michelson G, Patzelt A, Harazny J. Flickering light increases retinal blood flow. Retina. 2002; 22 (3) 336-343
75 Michelson G, Welzenbach J, Pal I. et al . Functional Imaging of the Retinal Microvasculature by Scanning Laser Doppler Flowmetry. International Ophthalmology. 2001; 23 (4 - 6) 327-335
76 Miller K M, Quigley H A. Comparison of optic disc features in low-tension and typical open-angle glaucoma. Ophthalmic Surg. 1987; 18 882-889
77 Mitchell P, Smith W, Chey T. et al . Open-angle glaucoma and diabetes. The Blue Mountains eye study, Australia. Ophthalmology. 1997; 10 712-718
78 Mitchell P, Lee A J, Rochtchina E. et al . Open-angle glaucoma and systemic hypertension: The Blue Mountains Eye Study. J Glaucoma. 2004; 13 319-326
79 Monemi S, Spaeth G, DaSilva A. et al . Identification of a novel adult-onset primary open-angle glaucoma (POAG) gene on 5q22. Human Molecular Genetics. 2005; 14 725-733
80 Morsman C D, Bosem M E, Lusky M. et al . The effect of topical beta-adrenoceptor blocking agents on pulsatile ocular blood flow. Eye. 1995; 9 (3) 344-347
81 Motolko M, Drance S M, Douglas G R. Visual field defects in low-tension glaucoma. Comparison of defects in low-tension glaucoma and chronic open angle glaucoma. Arch Ophthalmol. 1982; 100 1074-1077
82 Nebes R D, Vora I J, Meltzer C C. et al . Relationship of deep white matter hyperintensities and apolipoprotein E genotype to depressive symptoms in older adults without clinical depression. Am J Psychiatry. 2001; 158 878-884
83 Ong K, Farinelli A, Billson F. et al . Comparative study of brain magnetic resonance imaging findings in patients with low-tension glaucoma and control subjects. Ophthalmology. 1995; 102 1632-1638
84 Pei Z, Cheung R T. Melatonin protects SHSY5Y neuronal cells but not cultured astrocytes from ischemia due to oxygen and glucose deprivation (abstract). J Pineal Res. 2003; 34 194-201
85 Phelps C D, Corbett J J. Migraine and low-tension glaucoma. A case-control study. Invest Ophthalmol Vis Sci. 1985; 26 1105-1108
86 Pillunat L E, Bohm A G, Koller A U. et al . Effect of topical dorzolamide on optic nerve head blood flow. Graefes Arch Clin Exp Ophthalmol. 1999; 237 495-500
87 Piltz J R, Bose S, Lanchoney D. The effect of nimodipine, a centrally active calcium antagonist, on visual function and macular blood flow in patients with normal-tension glaucoma and control subjects. J Glaucoma. 1998; 7 299-300
88 Pogorelov P. Wanddickenmessung retinaler Gefäße mittels Scanning-Laser-Doppler-Flowmetrie bei Gesunden und bei Patienten mit arterieller Hypertonie. Erlangen; Medizinische Dissertation 2003
89 Pogorelov P, Michelson G, Harazny J. et al . Measurement of Retinal Vessel Wall Thickness with Scanning-laser Doppler Flowmetry in Healthy Persons and in Patients with Arterial Hypertension. DOG Tagung. 2003; Poster
90 Quaranta L, Bettelli S, Uva M G. et al . Effect of Ginkgo biloba extract on preexisting visual field damage in normal tension glaucoma. Ophthalmology. 2003; 110 359-362
91 Rezaie T, Child A, Hitchings R. et al . Adult-onset primary open-angle glaucoma caused by mutations in optineurin. Science. 2002; 295 1077-1079
92 Riva C E, Harino S, Shonat R D. et al . Flicker evoked increase in optic nerve head blood flow in anesthetized cats. Neurosci Lett. 1991; 128 291-296
93 Riva C E, Falsini B, Logean E. Blood flow responses of the human optic nerve to luminance and chromatic flicker: correlation with magno- and parvocellular neural activity. Vision Science and Its Applications. Optical Society of America Technical Digest. 2000; 43-46
94 Rouhiainen H J, Terasvirta M E. Haemodynamic variables in progressive and non-progressive low tension glaucoma. Acta Ophthalmol. 1990; 68 34-36
95 Sack J, Healey D L, de Graaf A P. et al . The problem of overlapping glaucoma families in the Glaucoma Inheritance Study in Tasmania (GIST). Ophthalmic Genet. 1996; 17 209-214
96 Sampaolesi J, Tosi J, Darchuk V. et al . Antiglaucomatous drugs effects on optic nerve head flow: design, baseline and preliminary report. Int Ophthalmol. 2001; 23 359-367
97 Schmetterer L, Findl O, Fasching P. et al . Nitric oxide and ocular blood flow in patients with IDDM. Diabetes. 1997; 46 653-658
98 Schmidt K G, von Ruckmann A, Pillunat L E. Topical carbonic anhydrase inhibition increases ocular pulse amplitude in high tension primary open angle glaucoma. Br J Ophthalmol. 1998; 82 758-762
99 Sellmayer A, Schrepf R, Theisen K. et al . Stellenwert von Omega-3-Fettsäuren in der kardiovaskulären Prävention. Dtsch Med Wochenschr. 2004; 129 1993-1996
100 Soares A S, Artes P H, Andreou P. et al . Factors associated with optic disc hemorrhages in glaucoma. Ophthalmology. 2004; 111 1653-1657
101 Sponsel W E, Paris G, Trigo Y. et al . Latanoprost and brimonidine: therapeutic and physiologic assessment before and after oral nonsteroidal antiinflammatory therapy. Am J Ophthalmol. 2002; 133 11-18
102 Stewart W C, Osterman J. Serum lipid physiology and the influence of glaucoma medications. Surv Ophthalmol. 1998; 43 233-244
103 Stroman G A, Stewart W C, Kolnik K C. et al . Magnetic resonance imaging in patients with low-tension glaucoma. Arch Ophthalmology. 1995; 113 168-172
104 Sugiyama T, Schwartz B, Takamoto T. et al . Evaluation of the circulation in the retina, peripapillary choroid and optic disk in normal-tension glaucoma. Ophthalmic Res. 2000; 32 79-86
105 Suzuki J, Tomidokoro A, Araie M. et al . Visual field damage in normal-tension glaucoma patients with or without ischemic changes in cerebral magnetic resonance imaging. Jpn J Ophthalmol. 2004; 48 340-344
106 Szapary L, Horvath B, Marton Z. et al . Short-term effect of low-dose atorvastatin on haemorrheological parameters, platelet aggregation and endothelial function in patients with cerebrovascular disease and hyperlipidaemia (abstract). CNS Drugs. 2004; 18 165-172
107 Tezel G, Kass M A, Kolker A E. et al . Comparative optic disc analysis in normal pressure glaucoma, primary open angle glaucoma, and ocular hypertension. Ophthalmology. 1996; 103 2105-2113
108 Tielsch J M, Katz J, Sommer A. et al . Hypertension, perfusion pressure, and primary open-angle glaucoma. A population based assessment. Arch Ophthalmol. 1995; 113 216-221
109 Tokunaga T, Kashiwagi K, Tsumura T. et al . Association between nocturnal blood pressure reduction and progression of visual field defect in patients with primary open-angle glaucoma or normal-tension glaucoma. Jpn J Ophthalmol. 2004; 48 380-385
110 Tomita G, Niwa Y, Shinohara H. et al . Changes in the optic nerve head blood flow and retrobulbar hemodynamics following calcium-channel blocker treatment of normal-tension glaucoma. Int Ophthalmol. 1999; 23 3-10
111 Turacli M E, Ozden R G, Gurses M A. The effect of betaxolol on ocular blood.ow and visual fields in patients with normotension glaucoma. Eur J Ophthalmol. 1998; 8 62-66
112 Tuulonen A, Airaksinen P J. Optic disc size in exfoliative, primary open angle, and low-tension glaucoma. Arch Ophthalmol. 1992; 110 211-213
113 Tutaj M, Brown C M, Brys M. et al . Dynamic cerebral autoregulation is impaired in glaucoma. J Neurol Sci. 2004; 220 49-54
114 van der Valk R, Webers C A, Schouten J S. et al . Intraocular Pressure-Lowering Effects of All Commonly Used Glaucoma Drugs. A Meta-analysis of Randomized Clinical Trials. Ophthalmology. 2005; 112 (7) 1177-1185
115 Vermeer S E, Hollander M, van Dijk E J. et al .Silent Brain Infarcts and White Matter Lesions increase Stroke Risk in the General Population. The Rotterdam Scan Study. Stroke 2003 34: 1126-1129
116 Vessani R M, Ritch R, Liebmann J M. et al . Plasma homocysteine is elevated in patients with exfoliation syndrome. Am J Ophthalmol. 2003; 136 41-46
117 Vetrugno M, Maino A, Cantatore F. et al . Acute and chronic effects of brimonidine 0.2 % on intraocular pressure and pulsatile ocular blood flow in patients with primary open-angle glaucoma: an open-label, uncontrolled, prospective study. Clin Ther. 2001; 23 1519-1528
118 Vickers J C, Craig J E, Stankovich J. et al . The apolipoprotein epsilon4 gene is associated with elevated risk of normal tension glaucoma. Mol Vis. 2002; 8 389-393
119 Waldmann E, Gasser P, Dubler B. et al . Silent myocardial ischemia in glaucoma and cataract patients. Graefes Arch Clin Exp Ophthalmol. 1996; 234 595-598
120 Weisschuh N, Neumann D, Wolf C. et al . Prevalence of myocilin and optineurin sequence variants in German normal tension glaucoma patients. Molecular Vision. 2005; 11 284-287
121 Wolde-Mussie E, Yoles E, Schwartz M. et al . Neuroprotective Effect of Memantine in Different Retinal Injury Models in Rats. J Glaucoma. 2002; 11 474-480
122 Wolf S, Arend O, Schulte K. et al . Quantification of retinal capillary density and flow velocity in patients with essential hypertension. Hypertension. 1994; 23 464-467
123 Wong T Y, Klein R, Sharett A R. et al . The Atherosclerosis in Communities Study. Cerebral white matter lesions, retinopathy and incident clinical stroke. JAMA. 2002; 288 67-74
124 Wood J P, Schmidt K G, Melena J. et al . The beta-adrenoceptor antagonists metipranolol and timolol are retinal neuroprotectants: comparison with betaxolol. Exp Eye Res. 2003; 76 505-516
125 Yamazaki Y, Drance S M. The relationship between progression of visual field defects and retrobulbar circulation in patients with glaucoma. Am J Ophthalmol. 1997; 124 287-295
126 Zeitz O, Matthiessen E T, Reuss J. et al . Effects of glaucoma drugs on ocular hemodynamics in normal tension glaucoma: a randomized trial comparing bimatoprost and latanoprost with dorzolamide [ISRCTN18873428]. BMC Ophthalmol. 2005; 5 6

Delia Baleanu

Universitäts-Augenklinik Erlangen

Schwabachanlage 06

91054 Erlangen

Phone: ++ 49/91 31/8 53 42 80

Email: delia.baleanu@augen.imed.uni-erlangen.de