The role of neuroinflammation in the pathogenesis of glaucoma neurodegeneration.

The chapter is a review enclosed in the volume "Glaucoma: A pancitopatia of the retina and beyond." No cure exists for glaucoma. Knowledge on the molecular and cellular alterations underlying glaucoma neurodegeneration (GL-ND) includes innovative and path-breaking research on neuroinflammation and neuroprotection. A series of events involving immune response (IR), oxidative stress and gene expression are occurring during the glaucoma course. Uveitic glaucoma (UG) is a prevalent acute/chronic complication, in the setting of chronic anterior chamber inflammation. Managing the disease requires a team approach to guarantee better results for eyes and vision. Advances in biomedicine/biotechnology are driving a tremendous revolution in ophthalmology and ophthalmic research. New diagnostic and imaging modalities, constantly refined, enable outstanding criteria for delimiting glaucomatous neurodegeneration. Moreover, biotherapies that may modulate or inhibit the IR must be considered among the first-line for glaucoma neuroprotection. This review offers the readers useful and practical information on the latest updates in this regard.

Fluorescein angiography of the iris and specular microscopy of the corneal endothelium in some cases of glaucoma secondary to chronic cyclitis.

A series is presented of middle- to old-aged female patients with gray irides and mild bilateral cyclitis accompanied by severe glaucoma with advanced cupping and field loss in the late stages. The cyclitis is accompanied by edema of the corneal endothelium, with the presence of inflammatory cells on the posterior surface of the endothelium; these changes were reversible with topical corticosteroids. There also was hypoperfusion of the iris with microneovascular changes, but these changes were not reversible. The rise in intraocular pressure (IOP) was associated with changes in the endothelial cells of the posterior cornea that may be accompanied by similar changes in the endothelium of the trabecular meshwork. A large proportion of these patients had sarcoidosis, but the more florid ocular appearances of sarcoid were not present although two patients had chorioretinal scarring. The use of topical corticosteroids was important in helping to control the elevated IOP in these cases. Recognition and treatment of the condition is important, because cupping and field loss were extreme in long-standing cases.