Next-Generation Glaucoma Therapies: A Systematic Review of Emerging Drug Innovations and Clinical Outcomes

Background: Glaucoma is a leading cause of irreversible blindness worldwide, primarily managed through intraocular pressure (IOP) reduction. Conventional treatments, including topical medications, laser therapy, and surgery, are limited by adherence challenges, disease progression despite adequate IOP control, and an incomplete understanding of glaucoma pathophysiology.Objectives: This systematic review evaluates the efficacy, safety, and clinical outcomes of emerging glaucoma therapies, including novel pharmacological agents, sustained-release drug delivery systems, neuroprotective agents, and investigational gene-based therapies.Methods: A systematic literature search was conducted in PubMed, Embase, Scopus, Cochrane Central, and Web of Science for studies published between ۲۰۱۵ and ۲۰۲۵. Eligible studies included randomized controlled trials (RCTs), observational studies, and interventional studies that assessed next-generation drug therapies in adults with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), ocular hypertension (OHT), or primary angle-closure glaucoma (PACG). Results: A total of ۲۲ studies comprising over ۲,۵۰۰ participants were included. Novel pharmacological agents, such as Rho kinase (ROCK) inhibitors (e.g., netarsudil) and nitric oxide-donating prostaglandins (e.g., latanoprostene bunod), demonstrated IOP reductions ranging from ۱.۶ to ۷.۰ mmHg, though some were associated with adverse effects such as conjunctival hyperemia (۲۰.۸–۶۱%). Sustained-release drug delivery systems, including bimatoprost and travoprost implants, maintained IOP reduction for up to ۶ months, improving adherence and reducing treatment burden. Neuroprotective therapies (e.g., brimonidine-based combinations) exhibited modest IOP reductions (۲.۳–۲.۶ mmHg) with potential quality-of-life benefits. Investigational gene-based approaches remain in early clinical stages, offering a promising avenue for future precision medicine strategies.Conclusions: Next-generation glaucoma therapies significantly reduce IOP, with sustained-release systems excelling in adherence and tolerability, while novel pharmacological agents provide alternative mechanisms of action. Despite these advancements, long-term efficacy, safety, and impact on visual field preservation remain areas for further research.

کلیدواژه ها:

Glaucoma ، Intraocular Pressure ، Rho kinase inhibitors ، sustained-release drug delivery ، Neuroprotection ، Gene Therapy ، Patient Adherence