Called in German green star (glaucoma) is a dangerous eye disease that often unnoticed leads to damage to the optic nerve and untreated in many cases causes blindness. If detected early and treated properly, progressive damage can be prevented in most cases. The modern definition of glaucoma refers primarily to the evidence of deterioration (progression) of the disease. This means that not only the intraocular pressure is an important parameter in the assessment and diagnosis.
There are many forms of the glaucoma. Among other things, a distinction is made between innate and acquired forms, depending on the structure of the eyeball after glaucoma in narrow (narrow-angle glaucoma) or wide camera angle (wide-angle glaucoma), after disease progression suddenly (acute) or permanently (chronic), or after special forms such as inflammatory, after previous operations, after injury or after taking certain medications (eg cortisone). Also, there are glaucomas with normal intraocular pressure, which pose a particular challenge to the ophthalmologist.
For the early detection of the Green Star various options are available. The basic examination involves the identification of risk factors through a specific questioning (anamnesis) of the patient. The measurement of the intraocular pressure can now be done without contact with an air pressure gauge (non-contact tonometer). Examination on the slit lamp with a contact glass after a drop of a local anesthetic agent allows the assessment of the chamber angle; It can thus be distinguished between narrow and wide-angle glaucoma and other forms. When the pupil is dilated, the optic nerve head can be judged by the reflection of the fundus. This examination is especially important for detecting damage to the optic nerve. Not infrequently, only minor changes in the optic nerve head indicate that glaucoma may exist. Then often an additional diagnostics is useful. With modern diagnostic equipment (measurement of the nerve fiber layer thickness GDxVCC) then usually a distinction between pathological or normal findings succeeds. Examination of the ocular fundus in red-free light may also be important by showing damage to the nerve fiber layer. Modern methods of visual field examination (computer perimetry) give us above all indications of an increase of damage (progression) on the optic nerve. Of particular importance is the knowledge of corneal thickness (pachymetry) in glaucoma patients in order to correctly assess the measured intraocular pressure values. With a very thin cornea, the measured value must be corrected upward, with a very thick cornea downward. All examinations are less stressful for the patient and can be performed on an outpatient basis. As a check-up we may only offer these as individual health services (IGeL). However, if glaucoma is detected, part of the diagnostics may be performed at the expense of the statutory health insurance (SHI).
There are many options available today for the treatment of the Green Star. Knowing the findings, your doctor will choose the best form of treatment for you. First, the target pressure you want to set is set; this is the intraocular pressure, where the progression of the damage seems unlikely. Dependent on the choice of the drug in drop form, which should reduce your intraocular pressure reliably to the desired value. This is monitored by intraocular pressure controls. If the administration of drops alone is not sufficiently effective, it is possible to administer additional drops or change the treatment to a drop containing several active substances. This is done taking into account existing general conditions and possible side effects of the therapy. If, during the course of the disease, no sufficient reduction in intraocular pressure with drugs is detectable, or a drop of e.g. due to incompatibilities, surgical treatments may be required.
When choosing the drug for lowering the intraocular pressure, numerous preparations are available today. Our health insurance companies expect today from the attending physician an economic prescription method. This means, on the one hand, that only a few original drugs can be prescribed today and most of the prescriptions have to be covered by copycat drugs (generics), on the other hand, the treating physician must inform patients in case of increased consumption of medication about possible consequences.
We have various surgical procedures available today. Common to all is the goal of lowering intraocular pressure. The only exceptions are the operations that are performed preventatively in narrow-angle glaucoma to prevent sudden increases in pressure. Here, a small hole in the iris (Iris) is created by laser (iridotomy) or with a small intervention, which provides a reliable protection against sudden pressure increases. The laser treatment of the chamber angle (laser trabeculoplasty LTP) can in many cases achieve a sufficient pressure reduction, is less stressful for the patient and can be carried out repeatedly. More aggressive measures include e.g. Filtering operations (trabeculectomy), which produce an artificial drainage of the eye water under the conjunctiva. In other uncontrollable forms of glaucoma methods are used, which cause a reduction in the production of the eye water. These include the obliteration of the radiation body by laser light (Cyklo-Photo-Coagulation CPK) or by a cold treatment (Cyklo-Cryo-Koagulation CCK).
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