SECTION III: INDIVIDUAL SYMPOSIUM PRESENTATIONS Framing Glaucoma Questions: What are the Opportunities for Glaucoma Treatment? A Personal Perspective
SECTION III: INDIVIDUAL SYMPOSIUM PRESENTATIONS Framing Glaucoma Questions: What are the Opportunities for Glaucoma Treatment? A Personal Perspective
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DOI：
10.1167/iovs.12-9483c
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发表时间：
2012-05-01
影响因子：
4.4
通讯作者：
Epstein, David L.
中科院分区：
文献类型：
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作者：
Epstein, David L.
100多年前，青光眼的治疗是最先进的眼科学科之一，包括特定的药物治疗（毛果芸香碱）和手术治疗（滤过）。[1]当时，对于视网膜或角膜疾病还没有特异性的治疗方法，白内障手术还采用了一些原始的技术，如卧位法。然而，世纪过去了，人们对青光眼的认识和治疗却落后于几乎所有其他眼科学科。开角型青光眼通常是两种组织的疾病：小梁网/Schlemm氏管传统流出系统，其负责眼内压升高;神经节细胞/轴突/视神经复合体，其负责青光眼中的视力丧失。然而，对于这两种病变组织中的任何一种，都没有真正有效的治疗方法。2-4例如，白藜芦醇主要靶向葡萄膜巩膜流出途径，5，6和β-受体阻滞剂减少流入，作用于睫状体。7，8虽然毛果芸香碱和类似的缩瞳药物可以增加流出，但它们的作用主要是在睫状肌上，增加小梁网的张力。9也就是说，对常规流出通道组织没有直接的内在影响。虽然肾上腺素样化合物可以增加传统的流出功能，10其对眼内压的多重影响是复杂的，11，12，有许多无反应的患者。13这类化合物不再用于治疗青光眼。Rho激酶抑制剂作为靶向常规流出途径的新型药物正在研究中。14
More than 100 years ago, the treatment of glaucoma was among the most advanced of ophthalmology disciplines, encompassing both specific medical therapy (pilocarpine) and surgical therapy (filtration). 1 At that time, there were no specific treatments for retinal or corneal disease, and primitive techniques, such as couching, were being used for cataract surgery. A century later, however, the understanding of glaucoma and therapy for the disease seem to lag behind those in almost all other ophthalmology disciplines.Open-angle glaucoma is, in general, a disease of two tissues: the trabecular meshwork/Schlemm’s canal conventional outflow system, which is responsible for intraocular pressure elevation, and the ganglion cells/axons/optic nerve complex, which is responsible for the visual loss in glaucoma. 2 Yet, there are no truly effective therapies for either of these two diseased tissues. 2–4 For example, prostaglandins target primarily the uveoscleral outflow pathway, 5, 6 and ß-blockers decrease inflow, acting at the ciliary body. 7, 8 Although pilocarpine and similar “miotic” drugs can increase outflow, their effects are primarily on the ciliary muscle, increasing tension in the trabecular meshwork. 9 That is, there is no direct intrinsic effect on the conventional outflow pathway tissue. Although epinephrine-like compounds can increase conventional outflow facility, 10 its multiple effects on intraocular pressure are complex, 11, 12 and there are many nonresponder patients. 13 Such compounds are no longer used to treat glaucoma. Rho kinase inhibitors are under study as novel drugs that target the conventional outflow pathway. 14