Emerging roles of the immune microenvironment in glaucoma

Glaucoma is a common blinding eye disease characterised by chronic and progressive degeneration of the optic nerve. Recent studies have increasingly shown that the pathological process of glaucoma involves not only traditional factors such as elevated intraocular pressure (IOP) but also significant changes in the immune microenvironment surrounding the optic nerve. Immune cells within this microenvironment, including macrophages, microglia, and T cells, play crucial roles in the pathogenesis of glaucoma. The activation and infiltration of these immune cells, along with the accompanying neuroinflammatory responses, may exacerbate damage to retinal ganglion cells (RGC) through the release of pro-inflammatory cytokines and chemokines. The dysregulation of these immune factors not only promotes RGC apoptosis but also affects the outflow pathways of aqueous humour, leading to further elevation of IOP. This review summarises recent advances in the study of the immune microenvironment in glaucoma, explores its role in the disease pathogenesis, analyzes the immune regulatory networks associated with glaucoma, and discusses potential therapeutic strategies based on immune modulation. These studies offer new insights into the complex pathological mechanisms of glaucoma and provide novel targets for future treatments.