Review of glaucoma research

Abstract

This paper reviews publications in the field of glaucoma research from 1991 and 1992. The role of elevated intraocular pressure (IOP) is redefined. Raised IOP is not the only, but probably the most important risk factor in the development of glaucomatous optic nerve damage. The IOP threshold of 20-22 mm Hg may be too high for many patients to avoid progressive damage. Early surgical treatment is more successful than medical or laser treatment and is gaining importance. New techniques have made trabeculectomy safer. In patients with poor surgical prognosis antimetabolites such as 5-fluorouracil or mitomycin C may improve results considerably. However, these treatments need to be defined in their side effects as far as long-term results are concerned. Lasersclerostomy ab interno and ab externo minimize surgical trauma and promise better results in eyes with previous surgery. Contact-cyclo-photocoagulation renders results comparable to cyclo-cryo-coagulation with less perioperative side-effects. However, long-term results must be obtained before it can replace the older technique. Medical treatment on the step to clinical introduction (in Germany) are apraclonidine with less side effects than clonidin, topical carbonic anhydrase inhibitors (dorzolamide) and possibly prostaglandin F2alpha-ester such as PhXA34. Galenic modifications are gelrite, a heteropolymer and betaxolol suspension. Which patients with ocular hypertension to treat and which not to treat still is a therapeutic dilemma. Methods such as colour contrast, investigation of scotopic low-contrast vision and the pattern-electroretinogram promise earlier detection of glaucomatous damage than conventional computer perimetry or morphological methods.