thesis

Bedeutung zirkulatorischer retinaler Ergebnisse zur Differenzierung des Normaldruckglaukoms vom primären Offenwinkelglaukom

Abstract

In the given research paper the data of 149 fluorescein angiographies have been evaluated. A comparison between three diagnostic groups (primary open-angle glaucoma, normal tension glaucoma, normal subjects) has been carried out with special reference to patients with glaucoma in order to find out about differences and/or similarities between primary open- angle glaucoma and normal tension glaucoma. Following the aim of examining the pathogenesis of glaucoma desease more closely, clinical and morphological data, parameter of the visual field examination and the fluorescein angiography (arteriovenous passage time, increase in the dilution curve and fluorescein- filling time) have been evaluated. Mechanical and vascular hypotheses about the pathogenesis of glaucoma desease can be found in scientific literature. According to the vascular hypothesis, changes in the perfusion and lesser perfusion of the optic nerve head are considered to be the cause. Wether these come into existence or are a secundary consequence of the increase in intraocular pressure, is still left to discussion. In general the open-angle glaucoma is rather attributed to the mechanical hypothesis while the normal tension glaucoma is attributed to the vascular hypothesis. In this study the retinal circulation was evaluated with the help of the arteriovenous passage time. It was found to be significantly prolonged in glaucoma patients, while there was no significant difference between primary open-angle glaucoma and normal tension glaucoma. To evaluate the blood flow and the blood flow velocity, the increase in the dilution curve and the fluorescein-filling time were used. The latter is considered to be a parameter independent of intensity and quality and is more suitable for the comparison between individuals. Glaucoma patients showed diminished increase and prolonged fluorescein-filling time than the normal subjects. No significant differences could be found between primary open-angle glaucoma and normal tension glaucoma either. Despite the fact that patients with primary open-angle glaucoma showed an increased intraocular pressure when compared with patients with normal tension glaucoma, the diminished perfusion is the same in both groups. These results lead to the assumption, that vascular causes become important in normal tension glaucoma as well as in primary open-angle glaucoma. Thus the evaluation of retinal circulation is important for the examination of glaucoma desease

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