Biomarkers to Predict Glaucoma Surgical Success

Primary open-angle glaucoma (POAG) is a primary neuronal disease of the optic nerve without a definable cause which may require surgical intervention to prevent further visual loss and/or normalize intraocular pressure. Worldwide, POAG is the second leading cause of blindness; there are 45 million people today with POAG and bilateral blindness is present in 4.5 million people. We cataloged all known ocular biomarkers in the aqueous humor, trabecular meshwork, optic nerve, as well as systemic biomarkers in blood serum/plasma into four categories, namely, extracellular matrix (ECM), cell signaling molecules, aging/stress, and immunity-related changes. We present a theoretical model to show signaling pathways of the ECM, cell signaling, and innate immune response through activation of Toll-4 receptor and monocyte activation which may impact the success of glaucoma surgery. The innate immune system is driven by the danger signal, the low molecular weight hyaluronic acid, and the activation of monocytes which collectively may be useful in predicting surgical success in POAG.