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Einflüsse des trockenen Auges auf die Glaukomdiagnostik

Influence of dry eye syndrome on glaucoma diagnostic procedures

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Zusammenfassung

Etwa 50–60% aller Patienten mit chronischem Offenwinkelglaukom leiden auch an einem trockenen Auge mit einer Oberflächenstörung und haben eine verminderte Hornhautdicke. Bei bildgebenden Verfahren kommt es durch Symptome des trockenen Auges zu einer Abminderung und Verrauschung der gemessenen Signale, bei Perimetrieverfahren zu einer diffusen Empfindlichkeitsminderung. Mögliche Einflussfaktoren auf neue Perimetrieverfahren wie Frequenzverdopplungsperimetrie (FDT), Flicker-Defined-Form (FDF)-Perimetrie und Pulsarperimetrie (PP) entstehen beim trockenen Auge möglicherweise durch Streulicht und vermindertes Kontrastsehen. Bei Glaukompatienten mit Oberflächenstörungen sollten deshalb insbesondere Verfahren mit hoher Sensitivität und geringerer Spezifität bei Verlaufskontrollen einer kritischen Plausibilitätskontrolle durch den Untersucher unterzogen werden. Bei unkritischer Anwendung der genannten Verfahren besteht die Gefahr einer Überinterpretation im Sinne einer nicht vorhandenen Glaukomprogredienz. Gegebenenfalls ist eine Vorbehandlung mit Tränenersatzmitteln oder eine Umstellung auf unkonservierte topische Antiglaukomatosa sinnvoll. Danach sollten erneute Kontrollmessungen erfolgen, um ein pseudoprogredientes Glaukom auszuschließen.

Abstract

Approximately 50–60% of primary open angle glaucoma patients suffer from dry eye and ocular surface disease and have a reduced corneal thickness. The measurements by imaging procedures are weakened by signal noise and perimetry procedures are affected by generalized loss of sensitivity. In dry eye patients, possible influences on new perimetry procedures, such as frequency doubling technology (FDT), flicker-defined form (FDF) perimetry and pulsar perimetry (PP) potentially result from stray light and reduced contrast sensitivity. In glaucoma patients with ocular surface disturbances, measuring procedures with high sensitivity and low specificity should be carefully checked for plausibility by the examiner. Using these procedures uncritically involves the danger of over interpretation in terms of non-existent glaucoma progression. If necessary, eyes should be pretreated with lubricating eye drops or therapy should be switched to preservative-free pressure lowering drops. Afterwards, new control measurements should be taken to exclude glaucoma pseudoprogression.

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Rüfer, F., Erb, C. Einflüsse des trockenen Auges auf die Glaukomdiagnostik. Ophthalmologe 109, 1082–1086 (2012). https://doi.org/10.1007/s00347-012-2640-x

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