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Advances in the Diagnosis and Treatment of Glaucoma
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Advances in the Diagnosis and Treatment of Glaucoma

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: 15 December 2025 | Viewed by 2333

Special Issue Editor

Dr. Alessio Martucci

E-Mail Website
Guest Editor
Ophthalmology Unit, Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
Interests: glaucoma; clinical research; neuro-ophthalmology; artificial intelligence; ophthalmology; anterior segment

Special Issue Information

Dear Colleagues,

This Special Issue focuses on the latest innovations and emerging strategies in the diagnosis and treatment of glaucoma, a leading cause of irreversible blindness worldwide. With the advent of advanced imaging modalities, such as optical coherence tomography (OCT) and OCT angiography, clinicians are now better equipped to detect glaucoma at its earliest stages. Artificial intelligence and machine learning algorithms are further enhancing diagnostic precision and disease monitoring. On the therapeutic front, the issue highlights novel pharmacologic agents, sustained-release drug delivery systems, and the growing role of minimally invasive glaucoma surgeries (MIGS). It also explores personalized medicine approaches, including genetic profiling, neurodegeneration, and neuroprotective therapies, aimed at preserving vision beyond intraocular pressure control. By bringing together cutting-edge research and clinical perspectives, this issue aims to inform and inspire advancements in glaucoma management, improve patient outcomes, and encourage continued innovation in ophthalmology.

Dr. Alessio Martucci
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • OCT
  • glaucoma
  • MIGS
  • neuroprotection
  • drug delivery systems
  • artificial intelligence
  • pharmacologic agents
  • per-sonalized medicine

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Published Papers (3 papers)

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Research

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10 pages, 455 KB  
Article
Retinal Nerve Fiber Layer Changes Following Cataract Surgery in Patients with and Without Preperimetric Glaucoma
by Feliciana Menna, Laura De Luca, Mattia Calabro, Alessandro Meduri, Stefano Lupo and Enzo Maria Vingolo
J. Clin. Med. 2025, 14(20), 7255; https://doi.org/10.3390/jcm14207255 - 14 Oct 2025
Viewed by 237
Abstract
Background: Preperimetric glaucoma (PPG) is characterized by structural optic nerve damage without detectable functional impairment. Optical coherence tomography (OCT) is increasingly utilized to monitor glaucoma, though its reliability can be compromised by lens opacities. This study investigates retinal nerve fiber layer (RNFL) thickness [...] Read more.
Background: Preperimetric glaucoma (PPG) is characterized by structural optic nerve damage without detectable functional impairment. Optical coherence tomography (OCT) is increasingly utilized to monitor glaucoma, though its reliability can be compromised by lens opacities. This study investigates retinal nerve fiber layer (RNFL) thickness changes after cataract surgery in patients with and without PPG, aiming to assess potential diagnostic inaccuracies due to cataract-induced imaging artifacts. Methods: Thirty eyes from 30 patients undergoing cataract surgery were analyzed, divided into two groups: Group 1 (n = 15) without glaucoma and Group 2 (n = 15) with PPG diagnosed using the Global Glaucoma Staging System. RNFL thickness was measured using Spectral-Domain OCT before and one month after phacoemulsification. Statistical analysis was performed using SPSS v23.0. Results: Postoperative RNFL thickness increased significantly in both groups, with a greater mean change in the PPG group (mean increase: 13 µm vs. 7 µm in controls; p < 0.00001). The greatest changes were observed in the inferior quadrants (p < 0.001). Image quality improved by approximately 34% post-surgery (p < 0.001). Despite higher postoperative RNFL values, none of the PPG eyes were reclassified as normal. Conclusions: In eyes with mild nuclear cataract, lens-related signal attenuation reduces absolute RNFL values but, in this cohort, had negligible impact on structural diagnostic classification. OCT-based structural findings in early glaucoma should therefore be interpreted with caution in the presence of cataract—recognizing that measurement bias may alter thickness values without changing PPG classification. Cataract surgery improves OCT reliability and can refine subsequent glaucoma assessment. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Glaucoma)
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12 pages, 1571 KB  
Article
Retinal Vascular Density and Vessel Diameter in Sturge–Weber Syndrome Assessed by OCT-Angiography
by Rosa Longo, Elena Gusson, Erika Lorenzetto, Luca Polinelli, Mariaelena Malvasi, Giacomo Panozzo and Giorgio Marchini
J. Clin. Med. 2025, 14(19), 7061; https://doi.org/10.3390/jcm14197061 - 6 Oct 2025
Viewed by 460
Abstract
Background: Sturge–Weber syndrome (SWS) typically presents with a port-wine stain on the face, accompanied by leptomeningeal capillary malformations and ocular vascular anomalies. The aim of our study was to evaluate retinal vascular density and vessel diameter to better characterize the presence of vascular [...] Read more.
Background: Sturge–Weber syndrome (SWS) typically presents with a port-wine stain on the face, accompanied by leptomeningeal capillary malformations and ocular vascular anomalies. The aim of our study was to evaluate retinal vascular density and vessel diameter to better characterize the presence of vascular alterations. Methods: 15 patients diagnosed with Sturge–Weber syndrome and 15 healthy controls underwent comprehensive ophthalmologic evaluation, Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCTA), to evaluate the microvascular architecture of the retina and choroid. Results: Analysis of the processed images revealed a significant increase (p < 0.05 *) in the density of the deep capillary plexus in patients with SWS compared to healthy controls. Vascular diameter was found to be increased overall in several retinal vascular plexuses in SWS patients compared to controls, reaching statistical significance (p < 0.05 *) in the deep vascular complex. Conclusions: The findings from our analysis highlight the potential role of OCTA in predicting the progression or worsening of ocular diseases over time. The introduction of new assessment parameters offers additional perspectives in evaluating ocular health. Since this examination allows for the detection of changes in the morphology and density of blood vessels as revealed by OCTA, these changes can be correlated with disease progression and the effectiveness of therapies. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Glaucoma)
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Review

Jump to: Research

33 pages, 683 KB  
Review
Next-Gen Neuroprotection in Glaucoma: Synergistic Molecules for Targeted Therapy
by Alessio Martucci, Massimo Cesareo, Maria Dolores Pinazo-Durán, Francesco Aiello, Giulio Pocobelli, Raffaele Mancino and Carlo Nucci
J. Clin. Med. 2025, 14(17), 6145; https://doi.org/10.3390/jcm14176145 - 30 Aug 2025
Viewed by 1302
Abstract
Background: Glaucoma is a progressive optic neuropathy marked by retinal ganglion cells (RGCs), apoptosis, vascular insufficiency, oxidative stress, mitochondrial dysfunction, excitotoxicity, and neuroinflammation. While intraocular pressure (IOP) reduction remains the primary intervention, many patients continue to lose vision despite adequate pressure control. Emerging [...] Read more.
Background: Glaucoma is a progressive optic neuropathy marked by retinal ganglion cells (RGCs), apoptosis, vascular insufficiency, oxidative stress, mitochondrial dysfunction, excitotoxicity, and neuroinflammation. While intraocular pressure (IOP) reduction remains the primary intervention, many patients continue to lose vision despite adequate pressure control. Emerging neuroprotective agents—citicoline, coenzyme Q10 (CoQ10), pyruvate, nicotinamide, pyrroloquinoline quinone (PQQ), homotaurine, berberine, and gamma-aminobutyric acid (GABA)—target complementary pathogenic pathways in experimental and clinical settings. Methods: This literature review synthesizes current evidence on glaucoma neuroprotection, specifically drawing on the most relevant and recent studies identified via PubMed. Results: Citicoline enhances phospholipid synthesis, stabilizes mitochondrial membranes, modulates neurotransmitters, and improves electrophysiological and visual field outcomes. CoQ10 preserves mitochondrial bioenergetics, scavenges reactive oxygen species, and mitigates glutamate-induced excitotoxicity. Pyruvate supports energy metabolism, scavenges reactive oxygen species, and restores metabolic transporter expression. Nicotinamide and its precursor nicotinamide riboside boost NAD+ levels, protect against early mitochondrial dysfunction, and enhance photopic negative response amplitudes. PQQ reduces systemic inflammation and enhances mitochondrial metabolites, while homotaurine modulates GABAergic signaling and inhibits β-amyloid aggregation. Berberine attenuates excitotoxicity, inflammation, and apoptosis via the P2X7 and GABA-PKC-α pathways. Preclinical models demonstrate synergy when agents are combined to address multiple targets. Clinical trials of fixed-dose combinations—such as citicoline + CoQ10 ± vitamin B3, citicoline + homotaurine ± vitamin E or PQQ, and nicotinamide + pyruvate—show additive improvements in RGCs’ electrophysiology, visual function, contrast sensitivity, and quality of life without altering IOP. Conclusions: A multi-targeted approach is suitable for glaucoma’s complex neurobiology and may slow progression more effectively than monotherapies. Ongoing randomized controlled trials are essential to establish optimal compound ratios, dosages, long-term safety, and structural outcomes. However, current evidence remains limited by small sample sizes, heterogeneous study designs, and a lack of long-term real-world data. Integrating combination neuroprotection into standard care holds promise for preserving vision and reducing the global burden of irreversible glaucoma-related blindness. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Glaucoma)
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