The role of prostanoids in the modern management of glaucoma

Abstract

The history of glaucoma pharmacology begins in 1862 with the isolation of physostigmine from the calabar bean. The discovery of epinephrine’s intraocular pressure lowering capacity came just after WWI. During the 20th century, drug discovery and development accelerated, with the introduction of carbonic anhydrase inhibitors, beta-blockers (1970s), alpha-agonists and lately prostanoids(1990s).2 Prostanoids have been divided into PG analogues and prostamides because of differences in molecular structures. The drugs share a novel mechanism of action that produces a potent ocular hypotensive effect and a novel local adverse effect of increased iridial pigmentation. Anti-glaucoma medication targets different key pathophysiological aspects of the disease and overlap in the mechanisms of action of these drugs proved to be important. The development of a completely new class of drugs added to the suppressive armamentarium against this blinding condition. More drug variety skewed glaucoma care away from the theatre, effectively changing the timing of glaucoma surgery.