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EGS Guidelines on Neuroprotection
4th Edition

Neuroprotection and Glaucoma Treatment

Neuroprotection can be defined as a “therapeutic approach” aiming to directly prevent or significantly hinder neuronal cell damage. Since glaucoma patients can continue deteriorating in spite of an apparently well controlled IOP, the need for effective non-IOP related treatments is widely acknowledged. Several compounds have been neuroprotectant in preclinical studies. Only two have reached large scale clinical trials: a large long-term RCT using an NMDA antagonist, memantine, was analysed in 2008 with negative results.

More recently, the results from a multi-center RCT of adults with low-pressure glaucoma (Low-pressure Glaucoma Treatment Study, LoGTS) has been claimed to show that brimonidine may have neuroprotective properties in comparison to Timolol. No direct comparison has been done with other substances such as PG. However, the authors of the study and a systematic literature review have (both?) suggested that more substantial evidence is needed.
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