[Basic and clinical studies of pressure-independent damaging factors of open angle glaucoma].

Pathogenesis of open-angle glaucoma involves both pressure-dependent damaging factors and pressure-independent damaging factors. The high prevalence of open-angle glaucoma with normal pressure (normal-tension glaucoma) in Japan implies that treatment of pressure-independent damaging factors in Japanese open-angle glaucoma patients is of importance. In an attempt to investigate the roles of pressure-independent damaging factors in open-angle glaucoma, we carried out basic and clinical studies and obtained the following results. 1. The rate of deterioration of visual field after trabeculectomy in normal tension glaucoma patients with post-operative intraocular pressure (IOP) of 10 mmHg was found to be -0.25 dB/year of mean deviation (MD), suggesting that contribution of pressure-independent damaging factors to the deterioration of MD in open-angle glaucoma is around -0.25 dB/year of mean deviation (MD). 2. Experiments using isolated purified cultured retinal ganglion cells (RGCs) indicated that calcium-channel blockers and some of antiglaucoma drugs showed neuroprotective effects on RGCs at concentrations of 0.01 microM or higher. 3. In mice, damage to RGCs resulted in secondary degeneration of neurons and activation of glial cells in the lateral geniculate nucleous (LGN) and superior colliculus, and these secondary changes in the central nervous system (CNS) due to RGC damage was partly ameliorated by systemic administration of memantine. 4. Mice experimental high IOP glaucoma models could be established using laser irradiation of the limbal area, and the usefulness of Tonolab in IOP measurements of mice eye was confirmed. 5. Monkey experimental high IOP glaucoma models revealed that in the glaucomatous optic nerve head vaso-constrictive reactions to an alpha-1 agonist was abolished, while vasodilative reaction to a prostaglandin FP receptor agonist was retained. 6. In monkeys with experimental high IOP glaucoma, secondary damage to neurons in the LGN and the glial reaction to it were also found, similar to the mice experiments. In living monkeys the glial reaction in the LGN could be observed by means of positron emission tomography. 7. In the LGN of monkeys with experimental high IOP glaucoma, the M-cell system was preferentially damaged in the early stage, while in the later stages both the M- and P-cell systems were damaged. 8. In a single-instituted prospective double-blinded clinical trial, oral administration of nilvadipine at 4 mg/day, a DHP calcium-channel blocker, was found to significantly retard the visual field progression in normal tension glaucoma patients over 3 years, while significantly increasing the choroidal and optic nerve blood flow by about 35%. 9. A multi-instituted prospective double-blinded clinical trial in normal tension glaucoma patients revealed that the rate of MD deterioration under monotherapy with either topical nipradilol or timolol was around -0.05 dB/year, thought to be considerably slower than -0.25 dB/year, the commonly estimated rate of MD deterioration by pressure-independent damaging factors. The current results indicate the possibility of treatment of pressure-independent damaging factors of open-angle glaucoma in Japanese open-angle glaucoma patients with oral nilvadipine and topical anti-glaucoma agents.