CONCEPT exist in the diagnosis and treatment of glaucoma

and / or inhibit cell

Excess glutamate can be toxic to normal stimulation RGSS more N-methyl-D- aspartate (NMDA). The NMDA receptor is an important type of glutamate receptor, which can kill most active when the retinal ganglion cells. Memantine of amantidine, Showing promise for neuroprotective effect in glaucoma. Memantine interaction with non-competitive NMDA receptor blockade results in the toxic effects of glutamate, without significant effect on normal cell function. Most of the activation of NMDA receptors by glutamate, the better the effect of memantine blocks glutamate and prevents the death of ganglion cells. (49) <

/ p> The protein Bcl-2 gene plays a central role in the regulation of apoptosis. The family members Bcl-2 genes that promote programmed cell death are poor and Bax, in contrast, the expression of Bcl-2 and Bcl-XL suppresses the apoptotic program. To date, A-2 signaling pathways have been identified to induce increased expression of bFGF, Bcl-2 and Bcl-XL genes, and improve the availability of the major neurotrophic factors. By activating alpha -2 in the retina, brimonidine (Brimodin) is shown that increasing the expression of anti-apoptotic genes, thereby preventing retinal ganglion cells death and promote axonal growth (50). Brimonidine also neutralizes the Kainic acid, which is toxic to nerve cells.

antioxidants, radical scavengers superoxide dismutase, catalase and vitamin E are also useful found neuroprotective effect. ‘/ P>

calcium channel blockers (diltiazem, nicardipine Nilvadipin, Nifedipine, etc.), semax (neuropeptide Russia), Citicoline, eliprodil, etc. riluzole and L deprenal be as neuroprotective agents studied.

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with the many existing and new drugs classes of drugs are now available to lower IOP practitioners with complex decisions about treatment strategies for patients with glaucoma face. Traditionally, beta-blockers were used as the standard treatment for glaucoma, but other means, such as A-2-agonists, carbonic anhydrase inhibitors and prostaglandins have other options available to the clinician. More recently, a new group, namely, the group came on stage prostamides demands safety, efficacy and dosage of the treatment of patients, compliance to intermediaries that are already available.

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selected in the general anti-glaucoma compared to the following criteria:

efficiency of the most vital

systemic safety

The convenience of “/ p> The costs of ” / p “‘tolerances

Local

/ p> After the above criteria , beta-blockers, especially timolol, which is the most effective means outside the group, dominated the anti-glaucoma treatment. The drug is highly effective at reducing beat them 15-30 percent IOP, relatively inexpensive, with excellent tolerance of eye tissue is still very primary therapy for glaucoma recommended in the world. (What term systemic adverse effects on respiratory and cardiovascular systems, and issues such as depression, powerlessness, lack of libido, diabetes, and nocturnal hypo tension (51,52)). The lack of vigilance on the part of physicians can lead patients to death from cardio-vascular status asthmaticus or complications. Since the introduction of drugs in 1978 were 40 deaths were reported due to drugs. Systemic toxicity may be greatly reduced if the doctor is wise to advise the use of these drugs and take measures to prevent systemic absorption through specific distributors, the pressure on the lower puncta, or daily with once-a gel (Timolet JRC) application form. Selective beta-blockers such as betaxolol is relatively safe in patients with diseases of the respiratory tract, but is less effective than timolol.

pilocarpine continue to maintain its relevance in glaucoma, primary angle closure. The drug has a synergistic effect with beta-blockers, brimonidine group, and systemic acetazolamide and topical treatments. “/ P>

adrenergic agents (agonists) as dipivefrine, clonidine and apraclonidine limited concrete evidence, as it often involves the conjunctiva, allergies and other side effects, ‘including the reduction of the pressure infusion of the papilla.

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/ p> Latanoprost <<0.005% / p> / p> Bimatoprost <0.03% / p>

Travoprost 0.004%

Isopropyl Unoprostone

<0.12% / P>

1% brinzolamide (Azopt) “/ P>

brimonidine tartrate

Brimonidine is a selective 2-agonists. It is an analogue of clonidine. It is about 30 times more selective -2 and has a very low affinity for a -1. For this reason, mydriasis and lid was found with nonselective agonists such as clonidine.

The most important mechanism of action removed the suppression of aqueous formation, but it was also to some extent, thus increasing the flow of uvéoscléral -.

(The principal merit brimodine (Brimodin) is its safety profile relative position and demands for neuroprotection by upregulation of applied cell survival factors and nervous as bFGF1 in response to the activation of the A-2 adrenergic receptors and ocular to increase blood flow. (53-55)) The drug must be instilled twice daily and its effect will IOP reduction can be compared with timolol. The demerit is higher than low IOP. The limiting factor is their brimonidine allergic reactions such as follicular conjunctivitis and contact dermatoconjunctivis (about 30 percent of the eyes) which can be justified to stop the drug. shown in recent years, few reports of occurrence of uveitis after prolonged use of brimonidine tartrate. Other occasional side effects reported were fatigue, drowsiness and dry mouth. The recent introduction of brimonidine without preservatives would be far fewer allergies (50%) from the place of benzalkonium chloride, sodium chloride was used as a preservative. Therapeutics, it is as effective as briomonidine. <

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Prostaglandin analogues and prostamides <

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prostaglandins and prostamides are newer group of drugs . Despite their high cost, they gain a great importance due to their greater efficacy in reducing IOP only require instillation in 24 hours, and have a relatively safe profile, systemic (56-62) <

/ p> prostamides prostaglandin and have a common origin in the membranes of cells, but they come from different membrane lipids are mobilized and undergo their biosynthesis connections. Analogues of prostaglandin F2 alpha are coming from the derived arachidonic acid, an intermediate in the metabolism and education, but prostamides from a path where anandamide are different enzymes involved. Prostamides Although structurally similar in some respects, prostaglandins, prostamides different functional.

latanoprost, bimatoprost and travoprost are reported to reduce IOP by 30-40 percent and can the drug of choice as monotherapy in the eyes requiring IOP below target. Superior daily control (control 24 hours) with these medications, preventing spikes in connection with damage to eyes (56). A comparison of bimatoprost with timolol showed a statistically significant number of patients with bimatoprost specific target IOP reached at any moment to the use of timolol compared. (63) target IOP Latamoprost achieved, but often reached bimatoprost lowered IOP.

Prostaglandin analogues release of trabecular uvéoscléral without compromising performance or the production of aqueous humor. Outflows rose seems to be uvéoscléral by changes in the extracellular matrix and gives a relaxation of the ciliary.

Latanoprost is essentially a drug to improve performance. It is 50% better performance uvéoscléral (64-68) and 30% increase in trabecular output through a mechanism to explain the still. There is slight increase in flows, and (69). Latanoprost is indicated to increase the flow of blood to the optic nerve. (67, 68) <

/ p> Recent comparative studies Lataoprost be more effective than timolol Unoprostone and show less brimatoprost (56). Bimatoprost lowered IOP by 30% to around 78% of patients, whereas timolol achieved a reduction of 30% in 61% of patients. (56) Moreover, 62% of patients receiving bimatoprost are receive a 40% reduction in IOP compared to 35% of patients treated with timolol. The combination of latanoprost with timolol used once a day if a better IOP reduction of latanoprost to be alone. (69) only a few workers (70.71) represented a further decrease in IOP was used during pilocarpine four times daily with a single application of latanoprost.

The biggest disadvantage of prostaglandins prostamides and is significant ocular side effects such as conjunctival hyperemia (15%), stinging and burning (30-40%) and foreign body sensation (20-22%), manifested the eyelash growth, increased pigmentation of the iris and periorbital tissue, including eyes, cystoid macular edema, herpes simplex keratitis and uveitis.

These drugs are reported to the effectiveness of 10-20% for UV exposed brimatoprost, except in opaque bottles or latanoprost refrigerator. <