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Klin Monbl Augenheilkd 2012; 229(2): 112-118
DOI: 10.1055/s-0031-1299127
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Die wichtigsten ophthalmologischen Papillenveränderungen bei den Glaukomen

The Most Important Signs of a Glaucomatous Disc
C. Y. Mardin
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Publication History

17 November 2011

23 December 2011

Publication Date:
14 February 2012 (online)

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Zusammenfassung

Die gemeinsame Endstrecke primärer und sekundärer Glaukome ist die glaukomatöse Optikusatrophie mit der Folge der Funktionsbeeinträchtigung des Auges. Durch den Verlust von Axonen und Gliazellen kommt es zur spezifischen Atrophie des Sehnervenkopfs. Die Vergrößerung und Vertiefung der Exkavation mit gleichzeitigem Verlust des neuroretinalen Randsaums (NRR) wird begleitet von Veränderungen der retinalen Gefäße und der parapapillären Atrophie des retinalen Pigmentepithels. Die Veränderungen der retinalen Nervenfaserschicht infolge des Ganglienzellverlusts können früheste Zeichen der Atrophie darstellen. Aufgrund der ausgeprägten Variabilität der Papillenform und -größe beim Menschen kann die Beurteilung der Papille bei Extremvarianten schwierig sein. Blutungen des NRR und Veränderungen der Pulsationseigenschaften retinaler Gefäße in der Papille können prognostische Hinweise auf den Erkrankungsverlauf geben. Diese Zeichen sind ophthalmoskopisch mit geringem Aufwand beurteilbar und semiquantitativ evaluierbar. Sie legen die Grundlage für die Bewertung moderner bildgebender Messverfahren. Dieser Artikel fasst die von Jonas und anderen Autoren erarbeiteten Kriterien vor dem Hintergrund der modernen Bildgebung zusammen und ergänzt diese durch neue Erkenntnisse.

Abstract

Glaucomatous optic atrophy is the result of both primary and secondary glaucomas leading to functional defects. Loss of axons and ganglion cells leads to a specific atrophy of the optic nerve head. Increased cup size and depth with loss of neuroretinal rim tissue are accompanied by changes of the retinal vessels and juxtapapillary retinal pigment epithelium. Changes of the retinal nerve fibre layer, caused by ganglion cell loss may be earliest signs of glaucomatous atrophy. The marked variability of optic disc size and form may influence the quality of ophthalmoscopic evaluation in extreme variants. Peripapillary haemorrhages and changes of pulsation properties of the retinal venules may give prognostic information for the course of the disease. These signs may be evaluated and even semiquantitatively measured with limited technical effort. They lay the basis for the evaluation of modern imaging and measuring techniques. This article summarises criteria described by Jonas and other authors in the light of modern imaging techniques and adds the latest scientific results.

Schlüsselwörter

Glaukom - Papille - Ophthalmoskopie

Key words

glaucoma - optic disc - ophthalmoscopy
 

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