Klinik und Therapie des Steroidglaukoms

Abstract

In steroid responders, topical or systemic application of steroids leads to extracellular deposits in the trabecular meshwork which increase trabecular meshwork outflow resistance. 30-40 % of the normal population are steroid responders. About 5 % develop an intraocular pressure (IOP) rise of > 15 mmHg. These patients are termed "high responders". In patients with primary open angle glaucoma (POAG), the proportion of steroid responders sums up to 90 %. The extent of steroid response depends on the kind of steroid used and on the duration of its administration. Dexamethasone has the highest IOP increasing potency. Differential diagnoses are POAG, ocular hypertension, normal tension glaucoma, pseudoexfoliation glaucoma and secondary glaucoma due to different reasons. To make the diagnosis, a detailed anamnesis is crucial. A recompensated IOP after the end of steroid use proves the diagnosis. The treatment of steroid glaucoma includes topical antiglaucoma medications, glaucoma filtration surgery, trabeculotomy, and laser surgery. So far, only few comparative studies on different treatment options have been published on steroid glaucoma. In some cases of therapy-resistant IOP increases following intravitreal or subconjunctival steroid administration, operative removal of the steroids can be considered. A gene therapy treatment of steroid glaucoma is still a topic of research.