Der Einfluss von Medikamenten auf das Glaukom und den Augeninnendruck

Zusammenfassung

Hintergrund Eine Reihe von sehr unterschiedlichen Medikamenten können im Rahmen ihrer regulären Anwendung einen unerwünschten Einfluss auf den Augendruck, ein präexistentes Glaukom und die Wirksamkeit von Glaukommitteln ausüben.

Material und Methoden Aktuelle Literaturrecherche in PubMed. Eigene klinische Erfahrungen flossen in die Bewertung von Zusammenhängen ein.

Ergebnisse Topisch und systemisch applizierte Kortikosteroide haben einen komplexen Einfluss auf das trabekuläre Maschenwerk. Neue Erkenntnisse der Genetik verbessern das Verständnis der Pathogenese, obwohl noch viele Fragen offen sind. Arterielle Hypertonie und die antihypertensive Therapie können beide Einfluss nehmen auf Glaukomrisiko, Augendruck und okuläre Perfusion. Die insgesamt noch junge Anti-VEGF-Therapie ist evtl. assoziiert mit einem erhöhten Risiko dauerhafter Augendruckerhöhungen. Systemische Arzneimittel mit parasympathikolytischer Wirkkomponente (v. a. Psychopharmaka) können selten ein Winkelblockglaukom auslösen.

Schlussfolgerung Erkenntnisse über Zusammenhänge zwischen Arzneimitteln wie den systemischen Antihypertensiva und Kortikosteroiden und der glaukomatösen Optikusneuropathie betreffen große Patientengruppen und können auch das Verständnis über die Pathogenese der primären Offenwinkelglaukome verbessern. Es besteht ein großer Bedarf an weiterer klinischer und experimenteller Forschung.

Abstract

Purpose Systemic drugs may have unfavourable effects on intraocular pressure, glaucoma and the efficacy of glaucoma drugs.

Material and Methods The article provides a review of the literature from PubMed and clinical experience.

Results Topical and systemic corticosteroids induce complex changes inside the trabecular meshwork. New genetic results improve the understanding of pathogenetic processes, although many questions are still open. Arterial hypertension and antihypertonic drugs may influence the risk of glaucoma, intraocular pressure and ocular perfusion pressure. Intravitreal anti-VEGF therapy may be associated with the risk of sustained intraocular pressure elevation. Systemic drugs with parasympaticolytic activity (e.g. psychopharmaceuticals) are able to induce acute angle block glaucoma.

Conclusion New insights into the interactions between drugs (e.g. antihypertensives, corticosteroids) and glaucomatous optic neuropathy affect large patient groups and may improve understanding of the underlying pathogenetic processes in open angle glaucoma. There is a great need for further clinical and experimental research.

Schlüsselwörter

Medikamente - Glaukom - Augendruck - unerwünschte Wirkung - Kortikosteroide

Key words

drugs - glaucoma - intraocular pressure - side effects - corticosteroids

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