Wang Li-Hsin, Huang Chun-Hao, Lin I-Chan
School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan.
Department of Ophthalmology, Wan Fang Hospital, Taipei Medical University, Taipei 110301, Taiwan.
Pharmaceuticals (Basel). 2024 Sep 25;17(10):1261. doi: 10.3390/ph17101261.
Glaucoma is a major global health concern and the leading cause of irreversible blindness worldwide, characterized by the progressive degeneration of retinal ganglion cells (RGCs) and their axons. This review focuses on the need for neuroprotective strategies in glaucoma management, addressing the limitations of current treatments that primarily target intraocular pressure (IOP) reduction. Despite effective IOP management, many patients continue to experience RGC degeneration, leading to irreversible blindness. This review provides an overview of both pharmacological interventions and emerging technologies aimed at directly protecting RGCs and the optic nerve, independent of IOP reduction. Pharmacological agents such as brimonidine, neurotrophic factors, memantine, Ginkgo biloba extract, citicoline, nicotinamide, insulin, and resveratrol show promise in preclinical and early clinical studies for their neuroprotective properties. Emerging technologies, including stem cell therapy, gene therapy, mitochondrial-targeted therapies, and nanotechnologies, offer innovative approaches for neuroprotection and regeneration of damaged RGCs. While these interventions hold significant potential, further research and clinical trials are necessary to confirm their efficacy and establish their role in clinical practice. This review highlights the multifaceted nature of neuroprotection in glaucoma, aiming to guide future research and clinical practice toward more effective management of glaucoma-induced neurodegeneration.
青光眼是一个重大的全球健康问题，是全球不可逆性失明的主要原因，其特征是视网膜神经节细胞（RGCs）及其轴突的进行性退化。本综述重点关注青光眼治疗中神经保护策略的必要性，探讨了当前主要针对降低眼压（IOP）的治疗方法的局限性。尽管眼压得到了有效控制，但许多患者仍继续经历RGCs退化，导致不可逆性失明。本综述概述了旨在直接保护RGCs和视神经、独立于降低眼压的药物干预措施和新兴技术。诸如溴莫尼定、神经营养因子、美金刚、银杏叶提取物、胞磷胆碱、烟酰胺、胰岛素和白藜芦醇等药物在临床前和早期临床研究中因其神经保护特性而显示出前景。新兴技术，包括干细胞疗法、基因疗法、线粒体靶向疗法和纳米技术，为受损RGCs的神经保护和再生提供了创新方法。虽然这些干预措施具有巨大潜力，但需要进一步的研究和临床试验来证实其疗效并确定它们在临床实践中的作用。本综述强调了青光眼神经保护的多方面性质，旨在指导未来的研究和临床实践，以更有效地管理青光眼引起的神经退行性变。
