Balendra Shiama I, Shah Parth Arvind, Jain Mishank, Grzybowski Andrzej, Cordeiro Maria F
Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London. United Kingdom.
Department of Ophthalmology, The Princess Alexandra Eye Pavilion, Chalmers St, Edinburgh EH3 9HA. United Kingdom.
Curr Pharm Des. 2017;23(4):596-607. doi: 10.2174/1381612822666161129151308.
Glaucoma comprises a group of neurodegenerative diseases resulting in retinal ganglion cell death within the optic nerve head. It is projected to affect almost 80 million people worldwide by 2020. The condition's asymptomatic nature translates to over half of glaucoma sufferers being unaware of their condition. By the time of diagnosis, irreversible blindness is likely to have occurred. Prime areas of glaucoma research therefore include identification and optimization of risk factors for the disease, accurate and early diagnostic tools and novel therapeutic methods.
The goal of this review was to summarize main areas of latest glaucoma research into risk factors of glaucoma, diagnostic tools and treatments. PubMed was used to search for terms including glaucoma risk factors, glaucoma diagnostics, glaucoma treatment, glaucoma drug delivery and glaucoma IOP.
The evidence for risk factors of low CSF pressure, IOP, smoking, vascular risk factors and light toxicity is described. Latest diagnostic and monitoring techniques for glaucoma include SD-OCT, DARC and IOP telemetry. Current and emerging medical and surgical treatments in glaucoma are discussed. Rho kinase inhibitors have the potential to both lower IOP and also provide neuroprotection, several of which are in clinical trials. Several other new medical treatments such as calcium channel blockers and neurotrophic agents also have the capacity to provide neuroprotection. Minimally Invasive Glaucoma Surgery (MIGS) devices provide an improved safety profile compared to traditional trabeculectomy; the latest ab interno and ab externo devices are described. Novel drug delivery methods, including punctual plugs and contact lenses, help overcome the challenges with patient adherence.
The ultimate goals are to reduce the individual patient risk factors associated with glaucoma, diagnose the condition early and to find treatments that not only reduce IOP but also reverse neurodegeneration of RGCs. The usage of combinations of novel medical and surgical treatments may help maximize IOP reduction and neuroprotection.
青光眼是一组神经退行性疾病，可导致视神经乳头内的视网膜神经节细胞死亡。预计到2020年，全球将有近8000万人受其影响。这种疾病无症状的特性意味着超过一半的青光眼患者并未意识到自己患病。在确诊时，很可能已经发生了不可逆的失明。因此，青光眼研究的主要领域包括识别和优化该疾病的风险因素、准确且早期的诊断工具以及新颖的治疗方法。
本综述的目的是总结青光眼最新研究在危险因素、诊断工具和治疗方面的主要领域。使用PubMed搜索包括青光眼危险因素、青光眼诊断、青光眼治疗、青光眼药物递送和青光眼眼压等术语。
描述了低脑脊液压力、眼压、吸烟、血管危险因素和光毒性作为危险因素的证据。青光眼的最新诊断和监测技术包括频域光学相干断层扫描（SD-OCT）、动态轮廓眼压计（DARC）和眼压遥测。讨论了青光眼当前和新兴的药物及手术治疗方法。Rho激酶抑制剂有降低眼压并提供神经保护的潜力，其中几种正在进行临床试验。其他几种新的药物治疗方法，如钙通道阻滞剂和神经营养药物，也有提供神经保护的能力。与传统小梁切除术相比，微创青光眼手术（MIGS）设备具有更高的安全性；介绍了最新的内路和外路设备。新颖的药物递送方法，包括泪点塞和隐形眼镜，有助于克服患者依从性方面的挑战。
最终目标是降低与青光眼相关的个体患者危险因素，早期诊断病情，并找到不仅能降低眼压，还能逆转视网膜神经节细胞神经退行性变的治疗方法。新颖的药物和手术联合治疗的应用可能有助于最大限度地降低眼压并提供神经保护。
