The role of structural alterations and functional imbalance of the retinal neurovascular unit in the pathogenesis of glaucoma.

Abstract:

The neurovascular unit (NVU) is a sophisticated functional network comprising neurons, glial cells, and microvessels. NVU’s homeostatic imbalance plays a pivotal role in the pathogenesis of glaucoma. The disease mechanism can be attributed to disruptions within the interactive network among retinal ganglion cells, glial cells, and microvessels. Current research has increasingly focused on multi-target synergistic interventions aimed at restoring global NVU homeostasis. This provides novel avenues for neuroprotective strategies in glaucoma. This review summarizes the structural and functional alterations in these cellular components and discusses the interplay of multiple pathogenic mechanisms, including oxidative stress and inflammation, excitotoxicity, neurovascular uncoupling, dysregulation of intercellular communication, and impaired clearance of metabolic waste.