Department of Ophthalmology, Military Medical Institute, Warsaw, Poland.
Med Sci Monit. 2010 Nov;16(11):RA252-9.
Glaucoma is a group of eye diseases causing irreversible optic nerve damage. This review presents 4 elements of future glaucoma treatment strategies: baroprotection, vasoprotection, neuroprotection and gene therapy. New baroprotection includes compounds that alter the actin cytoskeleton (rho-kinase inhibitors, latrunculin, cytochalasin), new drugs that enhance aqueous outflow via the trabecular meshwork (statins, steroid antagonists) and via the uveoscleral route (EP2 agonists, 5-HT2 agonists), as well as new classes of components that suppress aqueous humor formation (cannabinoids). Vasoprotection includes blocking reperfusion injury (NOS-2 inhibitors, endothelin blockers, MMP-9 inhibitors). Concerning neuroprotection antiamyloids antibodies, erythropoietin and caspase inhibitors are discussed. Gene therapy may target various effectors: the trabecular meshwork (cytoskeleton regulatory proteins, miocyllin, MMPs), the ciliary body epithelium (genes modifying aqueous humor production, neuropeptides), the ciliary body cells (MMPs, genes of local PGs biosynthesis, ciliary muscle relaxants), the retinal ganglion cells (neurotrophin genes, anti-apoptotic genes), Müller cells (neurotrophins, GLAST) and conjunctiva (gene of chloramphenicol acetyltransferase, inhibitor p21). Experimental studies on the graft mesenchymal stem cells and mature retinal cells to replace the dead retinal ganglion cells are advanced. Immunotherapy, offering a vaccination, providing protection against loss of retinal ganglion cells, has been investigated.
青光眼是一组导致不可逆视神经损伤的眼部疾病。本综述提出了未来青光眼治疗策略的 4 个要素：眼压保护、血管保护、神经保护和基因治疗。新的眼压保护包括改变肌动蛋白细胞骨架的化合物（Rho-激酶抑制剂、Latrunculin、细胞松弛素）、通过小梁网（他汀类药物、甾体拮抗剂）和葡萄膜巩膜途径（EP2 激动剂、5-HT2 激动剂）增加房水流出的新药，以及抑制房水形成的新类成分（大麻素）。血管保护包括阻断再灌注损伤（NOS-2 抑制剂、内皮素拮抗剂、MMP-9 抑制剂）。关于神经保护，讨论了抗淀粉样蛋白抗体、促红细胞生成素和半胱氨酸蛋白酶抑制剂。基因治疗可能针对各种效应物：小梁网（细胞骨架调节蛋白、米奥西林、MMPs）、睫状体上皮（改变房水产生的基因、神经肽）、睫状体细胞（MMPs、局部 PG 生物合成基因、睫状肌松弛剂）、视网膜神经节细胞（神经营养因子基因、抗凋亡基因）、Müller 细胞（神经营养因子、GLAST）和结膜（氯霉素乙酰转移酶基因、p21 抑制剂）。正在研究将间充质干细胞和成熟视网膜细胞移植以替代死亡的视网膜神经节细胞的实验研究。免疫疗法提供了一种疫苗，提供了对视网膜神经节细胞丧失的保护，已经进行了研究。
