[Modern concepts in the pathogenesis and treatment of glaucoma]

The reduction of the visual performances in glaucoma may be explained by several theories. The most admitted theory, for the present, considers glaucoma as a progressive primitive optic neuropathy, having the origin at the retinal ganglion cells, associated with a disease of the sclero-corneal trabeculum, whose porosity is diminishing. The most important pathogenic hypothesis in glaucoma are: the vascular, the mechanical and the collagenic hypothesis. The vascular theory considers that the prolonged ischemia is a responsible for the neuronal alteration. In this process are participating a lot of factors: the intraocular pressure, the blood pressure and some other factors governing the vascular tone of the optic nerve (myogenic factors, metabolic factors, vasoactive factors, circulating hormones and endothelial factors). From therapeutical point of vue, these modern concepts are reflected in the new therapeutic perspectives, with a special attention for the axonal outflow and trabecular cell disfunction and also for the dysregulation of the cellular oxidoreduction.