Is There More to Glaucoma Treatment Than Lowering IOP?
Section snippets
Inhibition of activation of astrocytes
The activation of the astrocytes in the optic nerve head (ONH) and retina plays an essential role in the pathogenesis of GON.26, 28, 68 Both mechanical and ischemic stress can lead to activation of astrocytes. Once activated, astrocytes upregulate the production of various molecules, including matrix metalloproteinases (MMPs), nitric oxide synthase-2 (NOS-2), tumor necrosis factor-alpha (TNF-α), and endothelin, thereby creating an altered microenvironment leading to tissue remodelling and
Conclusion
Theoretically, a number of options are available to treat glaucoma. The different risk factors known lead through the same or similar pathomechanisms to GON. Therapeutically, we can either eliminate or mitigate risk factors or target defined pathogenic steps. Risk factors that can be influenced include increased IOP, low blood pressure, and vascular dysregulation. Pathogenic steps that can be targeted include activation of astrocytes, upregulation of NOS-2 or MMPs. At the moment any type of
Method of Literature Search
A systematic search of the Medline database using the PubMed Web site (through 2007) was conducted using the following key words: non-IOP lowering treatment, POAG, oxidative stress, reactive oxygen species, astrocytes, epidermal growth factor receptor, tyrosine kinase inhibitor, Endothelin-1, Endothelin blockers, calcium channel blockers, dipyrimadole, nitric oxide synthase-2, aminoguanidine, fludrocortisone, carbonic anhydrase inhibitors, calcium channel blockers, omega-3-fatty acids,
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The authors reported no proprietary or commercial interest in any products mentioned or concepts discussed in this article.