The glaucomatous optic neuropathy: a reperfusion damage

Background: We introduce a pathogenetic concept which explains the present known clinical and experimental facts. Materials and methods: The known clinical risk factors for glaucomatous opt ic neuropathy as well as the outcomes of the experimental studies were syst ematically collected. Results: IOP fluctuations are more damaging than a stable increased IOP, re duced circulation due to vascular dysregulation is more damaging than reduc ed circulation due to arteriosclerosis and the glaucomatous damage is clear ly different from a pure ischemic lesion. Conclusions: Although IOP can damage mechanically, IOP fluctuation and bloo d pressure drops may lead to short term ischemia, followed by a reperfusion damage. A vascular dysregulation interferes with the autoregulation of ocu lar perfusion and renders the eye more sensitive to IOP increase or blood p ressure decrease.