Glaucoma neurodegeneration: targeted modulation of intraocular immune pathways – a review of novel therapeutic advances

Glaucoma is the leading global cause of irreversible blindness, with its pathogenesis extending far beyond elevated intraocular pressure. Dysregulation of the intraocular immune system plays a central role in the progressive death of retinal ganglion cells. This review systematically examines the research progress on key intraocular immune pathways in glaucomatous neurodegeneration, with a primary focus on immune-inflammatory responses mediated by microglia, astrocytes, and T cells. It delves into the molecular mechanisms of various immunoregulatory networks, including the TLR4/nuclear factor kappa B (TLR4/NF-κB), Janus kinase/signal transducer and activator of transcription (JAK/STAT), mitogen-activated protein kinase (MAPK), complement, and T-cell receptor signaling pathways. The review analyzes potential therapeutic strategies targeting these pathways. By integrating the latest evidence from basic research and translational medicine, this article aims to provide a theoretical foundation and directional guidance for developing neuroprotective immunomodulatory therapies that go beyond intraocular pressure reduction.