|
| | Anatomic target | Mechanism of action | Expected effect | Advantages | Disadvantages |
|
| Electrical stimulation | Trabecular meshwork (TM) | (i) Relaxation of TM, with less resistance to aqueous humor outflow | (i) Significant effect on lowering IOP | (i) Early stages of glaucoma
(ii) Facilitates the physiological pathway of the aqueous humor through TM towards Schlemm’s canal (SC) | (i) Not in advanced stages of glaucoma
(ii) Needs to be repeated |
|
| Micropulse cyclophotocoagulation (CPC) and ultrasound cyclomodification | Ciliary body | (i) Decrease the secretory activity of the ciliary epithelium | (i) Same IOP lowering effect as traditional CPC diode | (i) Advanced stages of glaucoma
(ii) Minimal heat diffusion
(iii) Less pain than traditional CPC | (i) Not in the early stages of glaucoma |
|
| Mesenchymal stem cells (MSCs) | Retinal ganglion cells (RGCs) | (i) Differentiation into retinal cell types (RGC)
(ii) production of growth factors | (i) Neuroprotective effects | (i) Pluripotency
(ii) Ease of extraction (bone marrow, adipose tissue)
(iii) Autologous transplantation | (i) Ethical issues |
|
| Exosomes | RGCs | (i) Translation of new proteins through mi-RNA-dependent mechanisms
(ii) RGC survival and preservation of function | (i) Neuroprotective effects | (i) Easily isolated and purified
(ii) Do not proliferate
(iii) Easily stored
(iv) Able to migrate
(v) Immunologically inert | (i) Not clear which dose for a therapeutic effect (weekly, biweekly, or monthly) |
|
| Optic nerve scaffolds | Optic nerve | (i) Stimulation and regeneration of damaged nerve fibers | (i) Neural regeneration | (i) Potential restoration of neural function | (i) Obstacles to neural regeneration: apoptosis of RGC, difficulty in triggering the axonal growth, inhibitory factors |
|
| ROCK inhibitors | Optic nerve and retinal ganglion cells | (i) Positive regulation of neural growth triggers | (i) Neural growth | (i) Augmented RGC survival | (i) Few studies to support this evidence |
|
| Neurotrophic factors (NF) | Optic nerve and retinal ganglion cells | (i) Interaction with macrophage-derived factors with immunomodulation | (i) Neural regeneration and growth | (i) Autologous molecules | (i) Local inflammation is needed to induce secretion of NF
(ii) Not selective
(iii) Reduced half-life |
|
| Alternating current stimulation (ACS) | Visual cortex and neural vision pathways | (i) Weak current pulses delivered to the brain | (i) Improvement of brain excitability and resynchronization of neuronal oscillation | (i) Very advanced glaucoma stages | (i) Few studies to support this evidence |
|
| Epiretinal, subretinal, and transchoroidal electrode implants | Optic nerve and RGCs | (i) Weak current pulses delivered to the eye | (i) Improvement of the optic nerve and retinal ganglion cell excitability | (i) Very advanced glaucoma stages
(ii) Low stimulation thresholds | (i) Invasive approach
(ii) Gliosis over the implant over time
(iii) Poor results described in the literature |
|
