Xinghuai Sun - Medical Treatment of Glaucoma

Editors

Xinghuai Sun and Yi Dai

Medical Treatment of Glaucoma

Editors

Xinghuai Sun

Eye & ENT Hospital, Shanghai Medical College of Fudan University, Shanghai, China

Yi Dai

Eye & ENT Hospital, Shanghai Medical College of Fudan University, Shanghai, China

ISBN 978-981-13-2732-2 e-ISBN 978-981-13-2733-9

https://doi.org/10.1007/978-981-13-2733-9

Springer Nature Singapore Pte Ltd. 2019

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Preface

The management of glaucoma has been considerably improved in the last three decades. On the basis of deeper understanding about the cellular, molecular, and genetic levels associated ocular changes, a large number of medications have been developed for the treatment of glaucoma. A number of potential new agents and new methods addressing the underlying pathophysiology of the disease are promising and may develop new therapeutic targets for the treatment of glaucoma in the future.

All chapters in this book are contributed by experts in the medical therapy and basic research of glaucoma around the world. With the great appreciation for chapter authors hard work, it is our sincere hope that this book will provide a comprehensive introduction to various aspects of medications in glaucoma and generate a deep re-understanding on medical treatment of glaucoma in practice. We are looking forward to hearing from the readers, whose critical comments will be much appreciated.

Xinghuai Sun

Yi Dai

Shanghai, China Shanghai, China

Contents

Dao-Yi Yu , Stephen J. Cringle and William H. Morgan

William H. Morgan and Dao-Yi Yu

Xiangmei Kong and Xinghuai Sun

Yuhong Chen , Kuan Jiang , Gang Wei and Yi Dai

Anna C. Momont and Paul L. Kaufman

Junyi Chen and Xinghuai Sun

Jacky Man Kwong Kwong and Iok-Hou Pang

Xueli Chen and Yi Dai

Enping Chen , Behrad Samadi and Laurence Qurat

Xinghuai Sun and Yi Dai

Glaucoma is an aetiologically complex disorder of optic neuropathies. Stressors related to age and intraocular pressure lead to progressive degeneration of the retinal ganglion cells. Clinically ophthalmic testing has been used to identify and quantify the functional and/or structural defects for diagnosis, assessing progression and therapeutic outcomes of glaucoma.

There are multiple ocular structures, which could involve the causes and consequences of glaucoma at the cellular, molecular and genetic levels associated with functional changes. In this chapter, we would like to describe some ocular structures and functions highly relevant to glaucoma.

No doubt, knowledge and information of retinal ganglion cells are critical for understanding glaucoma. The retinal ganglion cells are specialized projection neurons actively receiving visual signal through their dendrites and transmitting integrated visual information from the retina to the brain. Each subcellular component of the retinal ganglion cell is remarkably different in terms of structure, function and extracellular environment. Simplifying the retinal ganglion cells into a series of compartments, rather than attempting to understand it as a single, homogeneous structure, could be more useful for understanding pathogenic processes involved in optic neuropathies.

To understand the mechanisms of maintaining normal intraocular pressure and pathogenesis of elevated intraocular pressure, the only treatable risk factor, we need to understand aqueous humour formation, aqueous fluid dynamics and outflow pathways. This knowledge and information are fundamentally important for understanding the pathogenesis of glaucoma, particularly primary open angle glaucoma, and therapeutic interventions. The epithelium of the ciliary body, posterior surface of the iris and the lens play a role in aqueous humour production and/or barrier function. Endothelial cells line the inner surface of the cornea, trabecular meshwork, Schlemms canal, the collector channels and aqueous vein plexus, and the aqueous vein. This chapter provides updated information about the structure and function of the endothelium and epithelium.