Neuroprotektive Wirkungen von Antidiabetika in der Therapie von Patienten mit Diabetes und Glaukom oder hohem Glaukomrisiko

Zusammenfassung

Das Glaukom ist mit zahlreichen Risikofaktoren und internistischen Erkrankungen wie Diabetes mellitus Typ 2 verbunden. Der Typ-2-Diabetes-mellitus führt peripher und im Gehirn zu neurodegenerativen Veränderungen. Möglicherweise liegt in der Neurodegeneration auch eine Gemeinsamkeit in der Pathophysiologie und Ätiologie beider Erkrankungen. Interessanterweise scheinen zahlreiche Medikamente zur Therapie des Diabetes mellitus unabhängig von der Senkung des Blutzuckers neuroprotektive Eigenschaften aufzuweisen. Obwohl prospektive, randomisierte klinische Studien dazu noch fehlen, scheinen besonders Metformin und Glucagon-like-Peptide-1-Receptor-Agonisten (GLP-1-RA) neuroprotektive Effekte aufzuweisen. Die immer noch sehr häufig eingesetzten Sulfonylharnstoffe (z. B. Glibenclamid, Glimepirid) senken zwar sehr potent den Blutzucker, haben bez. der Neuroprotektion wohl vergleichsweise weniger Effekte. In der vorliegenden Übersicht werden diese unterschiedlich ausgeprägten neuroprotektiven Befunde dargestellt und eine mögliche Differenzialtherapie für Diabetiker mit Glaukom oder erhöhtem Glaukomrisiko in der Praxis diskutiert.

Schlüsselwörter

Glaukom - Neuroophthalmologie - Pharmakologie

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