Stellenwert vom Homocystein beim Glaukom

Zusammenfassung

In der multifaktoriellen Pathogenese der glaukomatösen Optikusatrophie spielen endotheliale Dysfunktion und vaskuläre Dysregulation eine Rolle. Eine Hyperhomocysteinämie als Risikofaktor für die endotheliale Dysfunktion ist sowohl mit dem primären Offenwinkelglaukom als auch mit dem sekundären Offenwinkelglaukom bei Pseudoexfoliationssyndrom assoziiert. In dieser Übersichtsarbeit wird die aktuelle Datenlage zur Assoziation zwischen Homocysteinmetabolismus und Glaukomerkrankung dargelegt sowie eine mögliche Rolle der Hyperhomocysteinämie in der Pathogenese und Progression der Glaukomerkrankung erläutert. Die Bedeutung von Homocystein für die Regulationsstörung der extrazellulären Matrix, der Vasotoxizität, der Neurodegeneration sowie der Epigenetik wird dargelegt. Die Prävention und Therapie der Glaukomerkrankung durch Beeinflussung des Homocysteinspiegels wird diskutiert.

Abstract

Endothelial dysfunction and vascular dysregulation play a role in the multifactorial pathogenesis of glaucomatous optic nerve atrophy. Hyperhomocysteinemia is a risk factor for endothelial dysfunction and is associated with primary open-angle glaucoma as well as secondary open-angle glaucoma in the pseudoexfoliation syndrome. This paper reviews the literature on the association between homocysteine metabolism and glaucomatous disease and explains the possible role of hyperhomocysteinemia in the pathogenesis and progression of glaucoma. We discuss the role of exogenous modifiable risk factors for the prevention and therapy of glaucoma, as well as modification of these factors by changes in life style, such as weight reduction, changes in nutrition and physical activity. The roles of homocysteine in regulating the extracellular matrix, vasotoxicity, neurodegeneration, and epigenetics are explained. Prevention and therapy of glaucoma by regulation of homocysteine levels are discussed.

Schlüsselwörter

Homocystein - Hyperhomocysteinämie - Offenwinkelglaukom - Vitamine - endotheliale Dysfunktion

Key words

homocysteine - hyperhomocysteinemia - open-angle glaucoma - vitamins - endothelial dysfunction

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