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Intraokulare Drucksteigerung bei Uveitis

Intraocular pressure related to uveitis

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Zusammenfassung

Das Glaukom ist eine häufige, oft schwerwiegende Komplikation intraokularer Entzündung und bleibt eine therapeutische Herausforderung. Bei Störung der Blut-Augen-Schranken gelangen Proteine, Entzündungsmediatoren und immunkompetente Zellen in das Auge. Diesen Mediatoren, v. a. Zytokinen und Chemokinen wird eine wichtige Rolle für die Entwicklung sekundärer Drucksteigerung zugesprochen. Pathomechanismen die zum Sekundärglaukom beitragen schließen Obstruktion des Trabekelmaschenwerks durch Entzündungszellen und Proteine, Trabekulitis, anteriore und/oder posteriore Synechien, Pupillarblock, Neovaskularisation und Verlagerung des Linsen-Iris-Diaphragmas ein. Als zusätzlicher Faktor sind Kortikosteroide, die zur entzündungshemmenden Behandlung eingesetzt werden, zu berücksichtigen.

Die Therapie der entzündungsassoziierter Glaukome erfordert einerseits eine adäquate, antientzündliche Behandlung und andererseits eine gleichzeitige Drucksenkung, um Folgeschäden zu vermeiden. Obwohl für beide Therapieziele zahlreiche, neue Wirkstoffe zu Verfügung stehen, bleibt die Druckkontrolle häufig unbefriedigend.

Abstract

Glaucoma, a common and potentially devastating complication of intraocular inflammation, remains a considerable therapeutic challenge. During uveitis, breakdown of the blood–ocular barrier occurs with subsequent influx of proteins as well as inflammatory and immunocompetent cells. These mediators, including cytokines and chemokines, are considered to have a major impact on secondary elevated intraocular pressure (IOP). Several mechanisms are involved in the pathogenesis of inflammatory glaucoma, including obstruction of the trabecular meshwork by inflammatory cells and proteins, trabeculitis, formation of anterior and/or posterior synechiae, pupillary block, neovascularization, and anterior rotation of the lens–iris diaphragm. In addition, the use of steroids to control intraocular inflammation may cause secondary elevation of IOP.

The management of uveitic glaucoma requires a careful balance between adequate anti-inflammatory therapy and appropriate lowering of IOP to prevent long-term visual loss. Despite the availability of many new medical treatments for both conditions, control of IOP in these patients remains challenging.

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Authors and Affiliations

  1. Universitäts-Augenklinik, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland

    U. Pleyer & P. Ruokonen

  2. Augenabteilung am St. Franziskus-Hospital, Münster, Deutschland

    C. Heinz & A. Heiligenhaus

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  1. U. Pleyer
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  2. P. Ruokonen
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  3. C. Heinz
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Correspondence to U. Pleyer.

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Pleyer, U., Ruokonen, P., Heinz, C. et al. Intraokulare Drucksteigerung bei Uveitis. Ophthalmologe 105, 431–437 (2008). https://doi.org/10.1007/s00347-008-1737-8

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