Melatonin as a therapeutic option for optic neuropathies

GONZÁLEZ FLEITAS, MARÍA F; ARANDA, MARCOS L; DIEGUEZ, HERNÁN H; DEVOUASSOUX, JULIÁN D; MILNE, GEORGIA A; CHIANELLI, MÓNICA S; KELLER SARMIENTO, MARÍA I; SANDE PABLO H; DORFMAN, DAMIÁN; ROSENSTEIN, RUTH E

Melatonin: Medical uses and role in health and disease

Nova Science Publishers

Año: 2018; p. 69 - 102

Glaucoma is a leading cause of irreversible blindnessworldwide, and provokes progressive visual impairment attributable to thedysfunction and loss of retinal ganglion cells and optic nerve axons.Currently, clinical interventions for glaucoma are mainly restricted to thereduction of intraocular pressure, one of the major risk factors for thedisease. However, lowering intraocular pressure is often insufficient to haltor reverse the progress of visual loss, underlining the need for thedevelopment of alternative treatment strategies.Optic neuritis, the most common optic neuropathyaffecting young adults, is a condition involving primary inflammation,demyelination, and axonal injury in the optic nerve which leads to retinalganglion cell death and visual dysfunction. Although corticosteroids are thecurrent mainstays of therapy for the treatment of optic neuritis, they fail toachieve long-term benefit on functional recovery, and provoke considerable sideeffects. Despite several differences between these diseases, glaucoma and opticneuritis are the two major degenerative causes of optic nerve damage, sharing acommon feature which is retinal ganglion cell loss and axonal damage. Althoughthe current management of glaucomais mainly directed at the control ofintraocular pressure, and the current therapy for optic neuritis mainly targetthe autoimmune response by using anti-inflammatory and immunosuppressiveagents, a neuroprotective therapy able to avoid the death of retinal ganglioncells and optic nerve fiber loss should be the main goal of treatment for bothdiseases. In this chapter, we will discuss evidence supporting theneuroprotective effect of melatonin, a very safe compound (even at high doses)for human use, which prevents and slows the progression of retinal ganglioncell and optic nerve axon damage induced by experimental glaucoma or opticneuritis in rodents, and as such, it coud be considered as a new therapeuticresource for the management of the most prevalent forms of optic neuropathy.