advertisement
Abstract #25954 Published in IGR 12-2
Medical treatment of primary open-angle glaucoma
Sredkova M; Vassileva PAutonomic and Autacoid Pharmacology 2010; 30: 49-50
Primary open angle glaucoma is a slowly progressive, chronic optic neuropathy, in which apoptosis and death of ganglion cells axons leads to loss of optic nerve tissue along with its supporting glia and vasculature. This phenomenon is referred as optic nerve 'cupping', or excavation. If sufficient axonal loss occurs, peripheral vision insidiously declines, but loss of central vision happens much later. Glaucoma can be diagnosed before clinical apparent peripheral vision loss via ophthalmoscopic examination of optic nerve head cupping and retinal fibre layer assessment. This is especially important in patients with one or more of the four main risk factors: advanced age, black race, positive family history and elevated intraocular pressure. There is no proven direct treatment for the optic neuropathy, so the treatment is focused on lowering intraocular pressure, the only one risk factor that can be modified. Normotensive glaucoma is similar to primary open angle glaucoma by optic nerve damage and characteristic visual field loss, but IOP is normal. In this disease is important to rule out other reasons for optic nerve atrophy. There is evidence for beneficial role of IOP lowering in reducing glaucomatous progression in normotensive glaucoma. IOP is reduced by decreasing the aqueous humour production or by increasing its outflow through trabecular meshwork, through uveoscleral pathway, or both. This review presents the last tendencies in medical therapy for glaucoma, separates the main groups of medicaments by their mechanism of action, and describes the indications for use according the stage of glaucomatous progression. Some drugs have been suggested to have direct neuroprotective effect. Medicaments, used as adjunctive therapy in glaucoma surgery are listed, including antimetabolites and intravitreal drugs. Problems with adherence and compliance to prescribed therapy are discussed and two clinical cases are presented.
M. Sredkova. SOBAL 'Pashev', SofiaBulgaria.
Classification:
11.1 General management, indication (Part of: 11 Medical treatment)
