Abstract
Glaucoma is a common degenerative disease affecting retinal ganglion cells (RGC) and optic nerve axons, with progressive and chronic course. It is one of the most important reasons of social blindness in industrialized countries. Glaucoma can lead to the development of irreversible visual field loss, if not treated. Diagnosis may be difficult due to lack of symptoms in early stages of disease. In many cases, when patients arrive at clinical evaluation, a severe neuronal damage may have already occurred. In recent years, newer perspective in glaucoma treatment have emerged. The current research is focusing on finding newer drugs and associations or better delivery systems in order to improve the pharmacological treatment and patient compliance. Moreover, the application of various stem cell types with restorative and neuroprotective intent may be found appealing (intravitreal autologous cellular therapy). Advances are made also in terms of parasurgical treatment, characterized by various laser types and techniques. Moreover, recent research has led to the development of central and peripheral retinal rehabilitation (featuring residing cells reactivation and replacement of defective elements), as well as innovations in diagnosis through more specific and refined methods and inexpensive tests.
Highlights
Glaucoma is a common degenerative disease affecting the retinal ganglion cells (RGC) and the optic nerve axons, with progressive and chronic course
New perspectives for future drug development to counter ocular hypertension by modulating aqueous humor dynamics derive from the identification of other specific targets, including the melatonin receptor 3 (MT3), endothelin-1 and the P2X2 receptor (Lee and Goldberg, 2011)
Neurotrophic factors, including ciliary neurotrophic factor (CNTF), brain-derived neurotrophic factor (BDNF), neuronal growth factor (NGF), and the glial cell line-derived neurotrophic factor (GDNF) are produced by cells within the retina, their concentration and the expression of their respective receptors are influenced in complex ways by axonal damage of the optic nerve, increased intraocular pressure (IOP) and introduction of exogenous neurotrophic factors (Perez and Caminos, 1995; Gao et al, 1997; Ju et al, 1999, 2000; Pease et al, 2000; Vecino et al, 2002; Wordinger et al, 2003; Rudzinski et al, 2004)
Summary
Glaucoma is a common degenerative disease affecting the retinal ganglion cells (RGC) and the optic nerve axons, with progressive and chronic course. It is one of the most important reasons of blindness in industrialized countries. In many cases, when a patient arrives at clinical evaluation, a severe neuronal damage may have already occurred. Several studies have calculated that more than half of patients with glaucoma isn’t aware of being affected. Pathogenesis and risk factors of glaucoma are multifactorial: the most relevant risk factor is represented by elevated intraocular pressure (IOP) (Figure 1), but familiarity, genetic patterns, race, age, and cardiovascular diseases play an important role, too (Coleman and Miglior, 2008). Drugs currently in use belong to five different classes and are
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