BIOCHEMICAL CHANGES IN GLAUCOMA AND THEIR IMPACT ON AQUEOUS HUMOR COMPOSITION

Abstract

Objectives. Primary open-angle glaucoma (POAG) is defined as an optic neuropathy due to high intraocular pressure; however, growing research suggests that metabolic and biochemical changes play an important role in disease pathogenesis. The purpose of this review is to summarize the most recent proteomic, metabolomic and immunologic data on biochemical changes in POAG and assess how these changes affect the aqueous humor’s composition.

Methods. A comprehensive literature review was conducted using PubMed, HINARI, Google Scholar databases. With a focus on investigations using proteomic, metabolomic and oxidative stress profiling, original research publications and systematic reviews examining the composition of aqueous humor in POAG patients were examined. Nuclear receptor signaling, metabolic pathways, inflammatory mediators and oxidative stress markers were all extensively assessed and integrated.

Results. POAG was shown to have consistent changes in the composition of aqueous humor, including raised levels of pro-inflammatory cytokines and complement components, dysregulation of energy and lipid metabolism, decreased antioxidant capacity, and increased oxidative stress indicators. Proteomic and metabolomic analyses showed that immunological and inflammatory pathways were activated, while glycolytic enzymes and mitochondrial proteins were suppressed. Furthermore, metabolic imbalance and persistent low-grade inflammation in the anterior chamber were found to be linked by the dysregulation of the LXR/RXR and FXR/RXR signaling pathways.

Conclusions. POAG is linked to a unique biochemical profile in aqueous humor that reflects the interaction of immunological activation, metabolic dysfunction, and oxidative stress. These changes may actively contribute to trabecular meshwork malfunction and disease progression. Beyond lowering intraocular pressure, aqueous humor-based multi-omics profiling has the potential to find clinically significant biomarkers and create personalized, mechanism-based treatment plans.