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Minerva Oftalmologica 2001 March-June;43(1-2):11-22

Copyright © 2001 EDIZIONI MINERVA MEDICA

language: Italian

Pharmacological treatment of glaucoma: therapeutic perspectives

Marrocco G., Rossi S., Oliva P., Capuano A., Rinaldi B., Mazzeo F.

Glaucoma is a group of diseases which share a characteristic, progressive form of optic nerve damage. Elevation of intraocular pressure (IOP) is usually associated with this form of optic nerve damage and an IOP higher than 21 mmHg should be considered suspicious. Elevated IOP, however, represents only a factor of risk for glaucoma. Other risk factors include a family history of glaucoma, diabetes mellitus, high myopia and cardiovascular diseases. The aging population has a significantly high risk of developing glaucoma, and with the increasing proportion of elderly in the general population this disease estimates may be rather low. Glaucomas are generally divided into a primary and a secondary group. The primary glaucoma occurs because of intrinsic ocular problems, while the secondary group occurs in relation to other eye or systemic diseases. The current therapy of glaucoma involves the use of parasympathomimetic agents (pilocarpine, carbachol, physostigmine, echothiopate) adrenergic agents (adrenaline, dipivefrine, clonidine, guanethidine, timolol, betaxolol) diuretics (acetazolamide) and prostaglandines (latanoprost). These drugs modify IOP by 3 mechanisms: increasing the outflow of aqueous humor through the trabecular meshwork; decreasing the production of aqueous humour from the ciliary body; and increasing the uveoscleral outflow of aqueous humour. Therapeutic perspectives include ethacrynic acid and non-psychoactive derivates of cannabinoids. Moreover, further contribution for the care of glaucoma may come from genic therapy in the next future.