Department of Glaucoma, Aravind Eye Hospital, Chennai, Tamil Nadu, India.
Department of Glaucoma, Chakrabarti Eye Care Centre, Trivandrum, Kerala, India.
Indian J Ophthalmol. 2022 Jun;70(6):1920-1930. doi: 10.4103/ijo.IJO_2239_21.
The burden of irreversible vision loss from Glaucoma continues to rise. While the disease pathogenesis is not well understood, intraocular pressure (IOP) is the only modifiable risk factor identified to prevent glaucomatous vision loss. Medical management remains the first-line of treatment in most adult glaucomas and the evolution of medical therapy for glaucoma has followed an exponential curve. This review tracks the rapid development of new medications and drug delivery systems in the recent years. Introduction of Rho kinase inhibitors with an entirely new mechanism of action from that of the currently used anti glaucoma medications has been a significant milestone. Latanoprostene Bunod is a novel, single molecule which provides two active metabolites that work through two different pathways for reducing intra ocular pressure. Bimatoprost implants and travoprost punctum plugs attempt to ease chronic medication use in glaucoma patients. Nanotechnology is an evolving route of drug delivery. Role of cannabinoids in medical management of glaucoma remain equivocal. The relatively short term effect on IOP, the risks of developing tolerance and side effects impacting patients' neurocognitive health greatly outweigh the potential benefit. Research on Latrunculin B, Adenosine receptor agonists, Specific gene silencing and Stem cell therapy are poised to make an impact on glaucoma treatment. While there is some evidence to support the role of Brimonidine in neuroprotection, further research is needed to clarify the role of Memantine and Neurotrophins. Evidence for benefit from dietary supplementation with Alpha lipoic acid, Forskolin , and Ginko Biloba is limited.
青光眼导致的不可逆转视力丧失的负担持续增加。尽管疾病的发病机制尚不清楚,但眼压(IOP)是唯一被确定可预防青光眼视力丧失的可调节风险因素。在大多数成人青光眼患者中,药物治疗仍然是一线治疗方法,而青光眼的药物治疗也经历了指数级的发展。本篇综述跟踪了近年来新药物和药物输送系统的快速发展。与目前使用的抗青光眼药物的作用机制完全不同的 Rho 激酶抑制剂的引入是一个重要的里程碑。拉坦前列素苯丁酸钠是一种新型的单一分子,它提供了两种活性代谢物,通过两种不同的途径降低眼内压。贝美前列素植入物和曲伏前列素泪点塞试图减轻青光眼患者的慢性药物使用。纳米技术是一种不断发展的药物输送途径。大麻素在青光眼的药物治疗中的作用仍然存在争议。在眼压方面的短期效果、产生耐受性和影响患者神经认知健康的副作用的风险极大地超过了潜在的益处。Latrunculin B、腺苷受体激动剂、特异性基因沉默和干细胞治疗的研究有望对青光眼治疗产生影响。虽然有一些证据支持溴莫尼定在神经保护方面的作用,但还需要进一步的研究来阐明美金刚和神经营养因子的作用。饮食补充α-硫辛酸、毛喉素和银杏叶提取物有益的证据有限。