Glaukompatient mit Verdacht auf Flammer-Syndrom: diagnostische Schritte und therapeutische Konsequenzen

 

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Zusammenfassung

Entwickelt sich ein Glaukomschaden trotz eines völlig normalen Augendruckes oder schreitet der Schaden trotz gut eingestellten Augendruckes weiter voran, dann finden wir meist andere Risikofaktoren. Eine wichtige Gruppe sind die vaskulären Faktoren. Dabei sollten wir uns nicht nur auf die klassischen Risikofaktoren der Arteriosklerose, wie die arterielle Hypertonie oder die Dyslipidämie fokussieren, sondern auch auf Fehlregulationen der Durchblutung, insbesondere auf die primäre vaskuläre Dysregulation (PVD). Ein tiefer Blutdruck, jetzt oder in der Jugend, ein niedriger Body-Mass-Index oder oft kalte Hände und Füße geben wichtige Hinweise. Sehr oft ist eine PVD gekoppelt mit einer Reihe von anderen Symptomen und Zeichen, dann sprechen wir von einem Flammer-Syndrom (FS). Bei Hinweisen auf ein FS machen wir eine gezielte Anamnese, eine 24-h-Blutdruckmessung, eine Messung des retinalen Venendruckes, eine dynamische retinale Gefäßanalyse oder eine Nagelfalz-Kapillarmikroskopie. Das empfiehlt sich insbesondere dann, wenn der Patient noch relativ jung ist oder der Schaden rasch fortschreitet. Erhärtet sich der Verdacht, dann versuchen wir, die Blutdruckabfälle zu vermindern, den retinalen Venendruck zu senken, die Regulation der Durchblutung zu verbessern und den oxidativen Stress in den Mitochondrien zu reduzieren.

Summary

If glaucoma damage develops despite normal intraocular pressure or if the damage progresses despite well-controlled intraocular pressure, we usually find other risk factors. One important group are the vascular factors. We should focus not only on the classical risk factors of atherosclerosis, such as arterial hypertension or dyslipidaemia, but also on dysregulation of blood flow, especially on primary vascular dysregulation (PVD). Low blood pressure, either current or in adolescence, low body mass index or frequently cold hands and feet may provide important hints. Very often PVD is coupled with a number of other symptoms and signs, and we then speak of a Flammer Syndrome (FS). If there is any indication of FS, we take a targeted patient history, undertake 24 h blood pressure monitoring, measure retinal venous pressure, and perform a dynamic retinal vessel analysis or nail fold capillary microscopy. This is especially recommended if the patient is relatively young or the damage is progressing rapidly. If the suspicion is confirmed, we then try to reduce the drops in blood pressure, lower the retinal venous pressure, improve the regulation of blood flow and reduce the oxidative stress in the mitochondria.

Publication History

Received: 29 October 2023

Accepted: 24 November 2023

Article published online:
23 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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