Delhi Institute of Pharmaceutical Sciences and Research, New Delhi, India.
Indian J Pharmacol. 2008 Oct;40(5):197-208. doi: 10.4103/0253-7613.44151.
Glaucoma is a slow progressive degeneration of the retinal ganglion cells (RGCs) and the optic nerve axons, leading to irreversible blindness if left undiagnosed and untreated. Although increased intraocular pressure is a major risk factor of glaucoma, other factors include increased glutamate levels, alterations in nitric oxide (NO) metabolism, vascular alterations and oxidative damage caused by reactive oxygen species. Glaucoma is the second leading cause of blindness globally, accounting for 12.3% of the total blindness. Glaucoma has been broadly classified as primary or secondary open-angle or angle-closure glaucoma. The primary goal in management of glaucoma is to prevent the risk factor, especially elevated intraocular pressure (IOP), using medications, laser therapy or conventional surgery. The first-line treatment of glaucoma usually begins with the use of a topical selective or nonselective blocker or a prostaglandin analog. Second-line drugs of choice include alpha-agonists and topical carbonic anhydrase inhibitors. Cholinergic agonists are considered third-line treatment options. When a single therapy is not sufficient to lower the IOP, a combination therapy is indicated. To enhance the patient compliance, drug delivery systems like electronic devices, ocular inserts, tansdermal and mechanical drug delivery systems have been developed. Use of viscoelastic agents in ophthalmic formulations, emulsions and soluble ophthalmic drug inserts (SODI) enhance patience compliance and ocular drug delivery in patients in long-term glaucoma therapy. For patients who do not respond to antiglaucoma medications, laser trabeculoplasty and incisional surgery are recommended. Several nutrients and botanicals hold promise for the treatment of glaucoma, but most studies are preliminary, and larger, controlled studies are required. Future directions for the development of a novel therapy glaucoma may target glutamate inhibition, NMDA receptor blockade, exogenously applied neurotrophins, open channel blockers, antioxidants, protease inhibitors and gene therapy.
青光眼是视网膜神经节细胞（RGCs）和视神经轴突的缓慢进行性变性，如果未经诊断和治疗，会导致不可逆转的失明。虽然眼内压升高是青光眼的主要危险因素，但其他因素包括谷氨酸水平升高、一氧化氮（NO）代谢改变、血管改变和活性氧引起的氧化损伤。青光眼是全球第二大致盲原因，占总失明人数的 12.3%。青光眼广泛分为原发性或继发性开角或闭角型青光眼。青光眼管理的主要目标是使用药物、激光治疗或传统手术来预防危险因素，特别是升高的眼内压（IOP）。青光眼的一线治疗通常始于使用局部选择性或非选择性阻滞剂或前列腺素类似物。二线药物选择包括α激动剂和局部碳酸酐酶抑制剂。胆碱能激动剂被认为是三线治疗选择。当单一疗法不足以降低 IOP 时，需要联合治疗。为了提高患者的依从性，已经开发了电子设备、眼内插入物、透皮和机械药物递送系统等药物递送系统。在眼科制剂、乳剂和可溶性眼科药物插入物（SODI）中使用粘弹性剂可以提高患者的依从性，并改善长期青光眼治疗患者的眼部药物递送。对于对抗青光眼药物治疗无反应的患者，建议进行激光小梁成形术和切开手术。一些营养物质和植物药有望治疗青光眼，但大多数研究都是初步的，需要更大规模的对照研究。治疗青光眼的新型疗法的未来方向可能是抑制谷氨酸、NMDA 受体阻断、外源性神经营养因子、开放通道阻滞剂、抗氧化剂、蛋白酶抑制剂和基因治疗。
