Fecal microbiota transplantation for glaucoma; a potential emerging treatment strategy

Abstract

Glaucoma is the primary cause of irreversible blindness globally. Different glaucoma subtypes are identified by their underlying mechanisms, and treatment options differ by its pathogenesis. Current management includes topical medications to lower intraocular pressure and surgical procedures like trabeculoplasty and glaucoma drainage implants. Fecal microbiota transplantation (FMT) is an almost effective and safe treatment option for recurrent Clostridium difficile infection. The relationship between bacterial populations, metabolites, and inflammatory pathways in retinal diseases indicates possible therapeutic strategies. Thus, incorporating host microbiota-based therapies could offer an additional treatment option for glaucoma patients. Here, we propose that combining FMT with standard glaucoma treatments may benefit those affected by this condition. Also, the potential safety, efficacy, cost-effectiveness and clinical applications are discussed.

Keywords: Fecal microbiota transplantation; Glaucoma; Intraocular pressure; Microbiota; Retinal diseases.

Graphical abstract

Fig. 1

The relationship between microbiota changes and glaucoma risk factors, including age-related changes, obesity, and anxiety/depression. Each peripheral factor highlights specific microbiota alterations and the corresponding effects on inflammatory and metabolic pathways, which may promote neuroinflammation and disease progression in glaucoma patients. IOP: intraocular pressure; BMI: body mass index.

Fig. 2

A schematic illustration of how gut microbiota dysbiosis influences glaucoma pathogenesis through pathways involving short-chain fatty acids production, TLR4 activation, immune cell activation, and microbial spread, contributing to neuroinflammation and retinal degeneration.

Fig. 3

Schematic representation of fecal microbiota transplantation (FMT) as a potential therapeutic approach for glaucoma through the gut-eye axis. This figure illustrates the hypothesized role of FMT in managing glaucoma by addressing gut dysbiosis and its impact on the gut-eye axis. The process begins with the collection and processing of fecal material from a healthy donor, which is then transplanted into a patient with gut dysbiosis. The aim is to restore microbial balance, thereby reducing systemic inflammation that may contribute to increased intraocular pressure in glaucoma patients. Post-transplantation assessments are made to evaluate glaucoma outcomes, analyze changes in the gut microbiome, and gather patient feedback, with continuous follow-up to ensure treatment efficacy and safety. This diagram highlights FMT as a novel approach to potentially modulate glaucoma progression by influencing gut microbial composition and systemic health.