Bilal Aigean, Constantin Farah, Chirila Sergiu, Hangan Tony
Emergency County Clinical Hospital "Sf. Apostol Andrei", Constanta, Romania.
Ovidius University, University Alle No.1, 900470, Constanta, Romania.
Int Ophthalmol. 2025 Sep 24;45(1):381. doi: 10.1007/s10792-025-03773-2.
This critical review explores current and emerging strategies for the management of open-angle glaucoma (OAG), highlighting pharmacological, laser-based, and surgical innovations. It aims to synthesize recent evidence, assess real-world applicability, and evaluate future directions in personalized glaucoma care.
A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Cochrane Library databases for English-language publications between January 2000 and May 2025. Studies on first-line therapies, combination treatments, microinvasive glaucoma surgery (MIGS), laser modalities, and novel drug delivery systems were included. The review presents an overview of significant advancements and future directions in glaucoma treatment.
Prostaglandin analogs remain the cornerstone of medical therapy, while fixed combinations and sustained-release implants improve adherence. Selective laser trabeculoplasty (SLT) has gained traction as a first-line treatment in mild OAG, though its effectiveness in advanced stages is limited. MIGS procedures are increasingly used as safer alternatives to traditional surgery, especially when combined with cataract extraction. Affordable goniotomy techniques and suprachoroidal approaches offer promising solutions in resource-constrained settings. Neuroprotection, vascular modulation, and caspase inhibition represent future adjunctive strategies. In Romania, glaucoma remains a major public health challenge, with limited treatment coverage and delayed diagnoses due to systemic gaps in education and screening.
Management of OAG is shifting toward patient-centered interventions that balance efficacy, safety, and accessibility. Continued integration of novel therapies, surgical innovation, and real-world cost-effectiveness data is essential for optimizing treatment algorithms, particularly in under-resourced health systems.
本综述探讨了开角型青光眼（OAG）管理的当前和新兴策略，重点介绍了药理学、激光和手术创新。其目的是综合近期证据，评估实际适用性，并评估个性化青光眼护理的未来方向。
在PubMed、Scopus、Web of Science和Cochrane图书馆数据库中进行了全面的文献检索，以查找2000年1月至2025年5月期间的英文出版物。纳入了关于一线治疗、联合治疗、微创青光眼手术（MIGS）、激光治疗方式和新型药物递送系统的研究。本综述概述了青光眼治疗的重大进展和未来方向。
前列腺素类似物仍然是药物治疗的基石，而固定复方制剂和缓释植入物可提高依从性。选择性激光小梁成形术（SLT）作为轻度OAG的一线治疗方法越来越受到关注，但其在晚期的有效性有限。MIGS手术越来越多地被用作传统手术的更安全替代方法，尤其是与白内障摘除术联合使用时。经济实惠的前房角切开术技术和脉络膜上腔入路在资源有限的环境中提供了有前景的解决方案。神经保护、血管调节和半胱天冬酶抑制代表了未来的辅助策略。在罗马尼亚，青光眼仍然是一项重大的公共卫生挑战，由于教育和筛查方面的系统性差距，治疗覆盖率有限且诊断延迟。
OAG的管理正朝着以患者为中心的干预措施转变，这些措施要平衡疗效、安全性和可及性。持续整合新疗法、手术创新和实际成本效益数据对于优化治疗方案至关重要，特别是在资源不足的卫生系统中。
