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Current concepts in the pathophysiology of glaucoma.

Agarwal R, Gupta SK, Agarwal P, Saxena R, Agrawal SS - Indian J Ophthalmol (2009 Jul-Aug)

Bottom Line: Extensive investigations into the pathophysiology of glaucoma now reveal the role of multiple factors in the development of retinal ganglion cell death.A better understanding of the pathophysiological mechanisms involved in the onset and progression of glaucomatous optic neuropathy is crucial in the development of better therapeutic options.The literature available in the National Medical Library and online Pubmed search engine was used for literature review.

View Article: PubMed Central - PubMed

Affiliation: Department of Ocular Pharmacology, Delhi Institute of Pharmaceutical Sciences and Research, New Delhi, India.

ABSTRACT
Glaucoma, the second leading cause of blindness, is characterized by changes in the optic disc and visual field defects. The elevated intraocular pressure was considered the prime factor responsible for the glaucomatous optic neuropathy involving death of retinal ganglion cells and their axons. Extensive investigations into the pathophysiology of glaucoma now reveal the role of multiple factors in the development of retinal ganglion cell death. A better understanding of the pathophysiological mechanisms involved in the onset and progression of glaucomatous optic neuropathy is crucial in the development of better therapeutic options. This review is an effort to summarize the current concepts in the pathophysiology of glaucoma so that newer therapeutic targets can be recognized. The literature available in the National Medical Library and online Pubmed search engine was used for literature review.

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Related in: MedlinePlus

The complex interplay of primary and secondary factors leading to RGC apoptosis in glaucoma. TNF-A - Tumor necrosis factor-alpha, ECM - Extracellular matrix, NOS-2 - Nitric oxide synthase-2
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Figure 0004: The complex interplay of primary and secondary factors leading to RGC apoptosis in glaucoma. TNF-A - Tumor necrosis factor-alpha, ECM - Extracellular matrix, NOS-2 - Nitric oxide synthase-2

Mentions: To summarize, the primary factors responsible for apoptotic cell death in glaucoma include not only elevated IOP but also vascular dysregulation, especially in people with NTG. The molecular mechanisms involved largely include glutamate excitotoxicity, increased MMP expression, TNF-alpha upregulation, increased NOS-2 expression and oxidative stress. The complex interrelationship between primary and secondary mechanisms involved in the pathophysiology of glaucoma is shown in Fig. 4. Although current therapeutic approaches, which primarily aim to lower the elevated IOP have shown great efficacy in saving the vision in glaucomatous optic neuropathy, further research to identify and develop pharmacological means with predominant neuroprotective effects is expected to provide better therapeutic options. Limited success so far in the development of effective neuroprotective therapy probably indicates the need of future research that incorporates multiple factors involved in the pathophysiology of neuronal damage in glaucoma.


Current concepts in the pathophysiology of glaucoma.

Agarwal R, Gupta SK, Agarwal P, Saxena R, Agrawal SS - Indian J Ophthalmol (2009 Jul-Aug)

The complex interplay of primary and secondary factors leading to RGC apoptosis in glaucoma. TNF-A - Tumor necrosis factor-alpha, ECM - Extracellular matrix, NOS-2 - Nitric oxide synthase-2
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2712693&req=5

Figure 0004: The complex interplay of primary and secondary factors leading to RGC apoptosis in glaucoma. TNF-A - Tumor necrosis factor-alpha, ECM - Extracellular matrix, NOS-2 - Nitric oxide synthase-2
Mentions: To summarize, the primary factors responsible for apoptotic cell death in glaucoma include not only elevated IOP but also vascular dysregulation, especially in people with NTG. The molecular mechanisms involved largely include glutamate excitotoxicity, increased MMP expression, TNF-alpha upregulation, increased NOS-2 expression and oxidative stress. The complex interrelationship between primary and secondary mechanisms involved in the pathophysiology of glaucoma is shown in Fig. 4. Although current therapeutic approaches, which primarily aim to lower the elevated IOP have shown great efficacy in saving the vision in glaucomatous optic neuropathy, further research to identify and develop pharmacological means with predominant neuroprotective effects is expected to provide better therapeutic options. Limited success so far in the development of effective neuroprotective therapy probably indicates the need of future research that incorporates multiple factors involved in the pathophysiology of neuronal damage in glaucoma.

Bottom Line: Extensive investigations into the pathophysiology of glaucoma now reveal the role of multiple factors in the development of retinal ganglion cell death.A better understanding of the pathophysiological mechanisms involved in the onset and progression of glaucomatous optic neuropathy is crucial in the development of better therapeutic options.The literature available in the National Medical Library and online Pubmed search engine was used for literature review.

View Article: PubMed Central - PubMed

Affiliation: Department of Ocular Pharmacology, Delhi Institute of Pharmaceutical Sciences and Research, New Delhi, India.

ABSTRACT
Glaucoma, the second leading cause of blindness, is characterized by changes in the optic disc and visual field defects. The elevated intraocular pressure was considered the prime factor responsible for the glaucomatous optic neuropathy involving death of retinal ganglion cells and their axons. Extensive investigations into the pathophysiology of glaucoma now reveal the role of multiple factors in the development of retinal ganglion cell death. A better understanding of the pathophysiological mechanisms involved in the onset and progression of glaucomatous optic neuropathy is crucial in the development of better therapeutic options. This review is an effort to summarize the current concepts in the pathophysiology of glaucoma so that newer therapeutic targets can be recognized. The literature available in the National Medical Library and online Pubmed search engine was used for literature review.

Show MeSH
Related in: MedlinePlus