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Secondary glaucoma: Toward interventions based on molecular underpinnings
Anna Mueller1,2, Isabel Lam3, Krishna Kishor1,4
1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
Wires Mechanisms of Disease
|September 5, 2023
Summary
Pseudoexfoliation and pigment dispersion syndromes cause secondary glaucoma by obstructing fluid outflow. New research suggests targeting melanogenesis and pseudoexfoliative material formation may offer novel therapeutic strategies.
Area of Science:
- Ophthalmology
- Molecular Biology
- Genetics
Background:
- Secondary glaucoma, including pseudoexfoliation and pigment dispersion syndromes, leads to irreversible blindness.
- Current treatments lack disease-specific interventions.
- Understanding the underlying mechanisms is crucial for developing targeted therapies.
Purpose of the Study:
- To re-evaluate the mechanistic possibilities of pseudoexfoliative glaucoma (PEXG) and pigmentary glaucoma (PG).
- To propose novel therapeutic targets for these conditions.
Main Methods:
- Review of multiomics analyses and current knowledge on PEXG.
- Analysis of pigment dispersion syndrome pathophysiology.
- Exploration of therapeutic insights from skin and melanoma research.
Main Results:
- PEXG formation involves nucleation centers, crosslinking enzymes, aberrant extracellular matrix, flawed endocytosis, and abnormal aqueous-blood barrier.
- Aberrant melanogenesis and cytotoxic intermediates contribute to PG.
- Prostanoid agonists, fenofibrates, and melatonin show potential therapeutic benefits.
Conclusions:
- Targeting melanogenesis is a promising strategy for PG.
- Melatonin offers antioxidant and hypotensive benefits for both PEXG and PG.
- Further research into these mechanisms could lead to effective interventions for secondary glaucoma.
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