title: New therapeutic targets for intraocular pressure lowering.
abstract: Primary open-angle glaucoma (POAG) is a leading cause of irreversible and preventable blindness and ocular hypertension is the strongest known risk factor. With current classes of drugs, management of the disease focuses on lowering intraocular pressure (IOP). Despite of their use to modify the course of the disease, none of the current medications for POAG is able to reduce the IOP by more than 25%-30%. Also, some glaucoma patients show disease progression despite of the therapeutics. This paper examines the new described physiological targets for reducing the IOP. The main cause of elevated IOP in POAG is thought to be an increased outflow resistance via the pressure-dependent trabecular outflow system, so there is a crescent interest in increasing trabecular meshwork outflow by extracellular matrix remodeling and/or by modulation of contractility/TM cytoskeleton disruption. Modulation of new agents that act mainly on trabecular meshwork outflow may be the future hypotensive treatment for glaucoma patients. There are also other agents in which modulation may decrease aqueous humour production or increase uveoscleral outflow by different mechanisms from those drugs available for glaucoma treatment. Recently, a role for the ghrelin-GHSR system in the pathophysiology modulation of the anterior segment, particularly regarding glaucoma, has been proposed.
authors.affiliation: Department of Sense Organs, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal ; Department of Ophthalmology, São João Hospital, 4200-319 Porto, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Rocha-Sousa
authors.affiliation: Department of Ophthalmology, São João Hospital, 4200-319 Porto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Rodrigues-Araújo
authors.affiliation: Department of Ophthalmology, São João Hospital, 4200-319 Porto, Portugal.
authors.forename: Petra
authors.initials: P
authors.lastname: Gouveia
authors.affiliation: Department of Ophthalmology, São João Hospital, 4200-319 Porto, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Barbosa-Breda
authors.affiliation: Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.
authors.forename: S
authors.initials: S
authors.lastname: Azevedo-Pinto
authors.affiliation: Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.
authors.forename: P
authors.initials: P
authors.lastname: Pereira-Silva
authors.affiliation: Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Leite-Moreira