Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South Wales, Australia; Department of Neuro-Ophthalmology, Moorfields Eye Hospital, London, United Kingdom.
Department of Ophthalmology, University of Auckland, Auckland, New Zealand; University of Melbourne, Parkville, Victoria, Australia.
Surv Ophthalmol. 2018 May-Jun;63(3):296-306. doi: 10.1016/j.survophthal.2017.09.010. Epub 2017 Oct 3.
A recent hypothesis to enter the literature suggests that glaucoma is a neurodegenerative disease. The basis for this has been the finding of central nervous system changes in glaucoma patients on histology and neuroimaging. It is known that retinal ganglion cell pathology of any cause leads to anterograde and retrograde retinal ganglion cell degeneration, as well as trans-synaptic (transneuronal) anterograde degeneration. Trans-synaptic degeneration has been demonstrated in a range of optic neuropathies including optic nerve transection, optic neuritis, and hereditary optic neuropathies. More recently, similar changes have been confirmed in glaucoma patients using the neuroimaging techniques of voxel-based morphometry and diffusion tensor imaging. Some studies have reported brain changes in glaucoma outside the retino-geniculo-cortical pathway; however, these are preliminary and exploratory in nature. Further research is required to identify whether the degenerative brain changes in glaucoma are entirely secondary to the optic neuropathy or whether there is additional primary central nervous system pathology. This has critical implications for neuroprotective and regenerative treatment strategies and our basic understanding of glaucoma.
最近有文献提出假说，认为青光眼是一种神经退行性疾病。这一假说的依据是在组织病理学和神经影像学研究中发现青光眼患者存在中枢神经系统改变。众所周知，任何原因导致的视网膜神经节细胞病变都会导致视网膜神经节细胞向前和向后退行性变，以及突触间（跨神经元）向前退行性变。在视神经横断、视神经炎和遗传性视神经病变等一系列视神经病变中已经证实了突触间退行性变。最近，使用基于体素的形态测量和弥散张量成像等神经影像学技术，在青光眼患者中也证实了类似的改变。一些研究报告了青光眼患者视路以外的大脑变化；然而，这些研究尚处于初步和探索性阶段。需要进一步的研究来确定青光眼患者的退行性脑改变是否完全是视神经病变的继发结果，还是存在额外的原发性中枢神经系统病变。这对神经保护和再生治疗策略以及我们对青光眼的基本认识具有重要意义。
