editorial challenging glaucomas: update on diagnosis and...

EditorialChallenging Glaucomas: Update on Diagnosis and Management

Gianluca Scuderi,1 Peng T. Khaw,2 Felipe A. Medeiros,3 and Gianluca Manni4

1Sapienza University of Rome, Via di Grottarossa No. 1039, 00189 Rome, Italy2National Institute Health Research (NIHR), Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust andUCL Institute of Ophthalmology, London, UK3UC San Diego Shiley Eye Center, San Diego, CA, USA4Tor Vergata University of Rome, Viale Oxford 8, 00133 Rome, Italy

Correspondence should be addressed to Gianluca Scuderi; [email protected]

Received 28 December 2015; Accepted 28 December 2015

Copyright © 2016 Gianluca Scuderi et al. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.

This special issue is focused on the current approaches usedto identify and manage particular groups of glaucoma thatwe define as challenging glaucomas, because of difficulties ineither diagnosis or therapy.

Malignant glaucoma is a good example of difficulties inboth diagnosis and management, and J. Foreman-Larkin etal. provide a complete overview on the clinical managementof malignant glaucoma. Pseudoexfoliation is also typified byvery high pressures at times and rapid damage to the opticnerve and P. Plateroti et al. focus their paper on pseudoex-foliation syndrome and pseudoexfoliative glaucoma with areview of the literature and updates on surgical management.Raised pressure and inflammation can be very challengingand D. Lewkowicz et al. cover the clinical outcome ofhypertensive uveitis. Infection after glaucoma surgery is oneof themost challenging situations andK.Ohtomo et al. reporttheir outcomes of late-onset bleb related endophthalmitistreated with pars plana vitrectomy.

The aetiology of different variants of the glaucoma withhigher and lower ranges of pressure still poses a challengeto us. D. Wrobel-Dudzinska et al. describe the risk factorsin normal-tension glaucoma and high-tension glaucoma inrelation to polymorphisms of the endothelin-1 gene and theendothelin-1 receptor typeA gene. Vascular changesmay playa part in the pathogenesis of glaucoma, and E. C. Koch etal. discuss blood pressure and heart rate variability in thedetection of vascular dysregulation in glaucoma.

Assessment of the cellular layers that get damaged mayprovide further clues in the assessment and diagnosis, and

A. Perdicchi et al. present a research article on the evaluationof agreement between HRT 3 and I-Vue OCT in glaucomaand ocular hypertension patients comparing different tomo-graphic approaches to evaluate retinal ganglion cells.

As the variety of topics presented in this special issue sug-gests, there are still many difficulties related to the diagnosisand therapies for glaucoma. This pathology, especially in itsmost advanced stages, can have a real impact on the qualityof life and outlook of patients. L. Zuo et al. write about visionhealth-related quality of life in Chinese glaucoma patients,describing how glaucoma can influence the quality of life inpatients.

There are some particular forms of glaucoma, whichmorethan others, represent a challenge for the ophthalmologist.For example, pigmentary glaucoma has many grey areasthat still need to be clarified, including its pathogenesisand the involvement of retinal structures. As mentioned,pseudoexfoliative glaucoma also presents many difficultiesfor both clinical and therapeutic approaches.However, paedi-atric forms of glaucoma represent one of the greatest clinicalchallenges, due to the variation in diagnostic criteria as wellas in potential treatments and the response of individualpatients. This is especially the case with those forms ofglaucoma secondary to other congenital diseases of theanterior segment of the eye, particularly if associated withfacial anomalies and other malformations of intraocularstructures. This group of disorders is particularly complexfor the ophthalmologist, with obstacles in the managementof these patients from diagnosis to treatment.

Hindawi Publishing CorporationJournal of OphthalmologyVolume 2016, Article ID 6935086, 2 pageshttp://dx.doi.org/10.1155/2016/6935086

2 Journal of Ophthalmology

However, daunting these challenges, the future looksencouraging as recent advances in translational research arereshaping modern ophthalmology including whole genomeanalysis and understanding of epigenetic influences andbioinformatics. This should allow the gradual identificationof the link between different clinical phenotypes and specificmutation in genes regulating the normal formation andmaturation of the eye, which should ultimately give rise tonew therapeutic hypotheses and approaches.

Thanks to nanotechnologies, new methods of drugadministration and the controlled release of molecules usedto decrease intraocular pressure are being developed. Surgicaltreatments are also moving forward with new minimallyinvasive procedures and with other devices which showpromising results with fewer side effects.

Furthermore, recent diagnostic criteria define glaucomaas a true neurodegenerative pathology, which affects notonly the eye but also the whole optic tract and possiblyinvolves the supportive cells of the central nervous system.This is the reason why, not only will future research focus onlowering IOP but also it will increasingly include therapieswith neuroenhancing and neuroprotective effects and, in themost optimistic hypotheses, will lead to neuroregeneration.

Gianluca ScuderiPeng T. Khaw

Felipe A. MedeirosGianluca Manni

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