title: Medical treatment of glaucoma: present and future.
abstract: BACKGROUND
  In the last decades, the therapy of glaucoma has largely shifted from surgery to medical treatment thanks to the introduction of strongly effective formulations, that is, prostaglandin analogs and fixed combinations. This clinical scenario may dramatically change in the future thanks to the progresses in biochemistry, genetics and drug delivery technology.
  
  
  METHODS
  This review covers the strategies currently used to achieve effective medical reduction of intraocular pressure in clinical practice; treatments that are currently been experimented in humans and that may be clinically available in the next few years; treatments at preclinical stages; and future goals of glaucoma treatment (gene therapy, ocular implants and neuroprotection).
  
  
  CONCLUSIONS
  Apart from an adequate reduction of intraocular pressure, effective glaucoma treatments should guarantee other characteristics: good tolerability, low problems of adherence and, possibly, multiple ways of action. From this viewpoint, a crucial clinical role may be played by drugs remodeling the trabecular meshwork (i.e., ROCK inhibitors, metalloproteinases). Other strategies such as the use of ocular implants for drug delivery, neuroprotection or gene therapy could renew glaucoma management in the future, but need long-term rigorous verification of safety and efficacy.
authors.affiliation: G. B. Bietti Foundation - IRCC, Rome, Italy. fogagnolopaolo@googlemail.com
authors.forename: Paolo
authors.initials: P
authors.lastname: Fogagnolo
authors.forename: Luca
authors.initials: L
authors.lastname: Rossetti
mesh_terms: D000818:Animals; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000378:metabolism; D005901:Glaucoma / Q000188:drug therapy* / Q000378:metabolism / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects / Q000502:physiology; D018696:Neuroprotective Agents / Q000008:administration & dosage / Q000378:metabolism; D009883:Ophthalmic Solutions / Q000008:administration & dosage / Q000378:metabolism; D011237:Predictive Value of Tests; D011453:Prostaglandins / Q000008:administration & dosage / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D018696:Neuroprotective Agents; D009883:Ophthalmic Solutions; D011453:Prostaglandins