The healing of ocular tissues: the basis of successful treatment of ocular disease.

Abstract

The processes of ocular wound healing are involved in either the pathogenesis or failure of treatment of many blinding and visually disabling conditions in the world today. In all these disorders, the severity and extent of clinical disease is closely related to the degree of scarring. Hence, in anterior segment disease, the complications of ocular surface disruption depend on the amount of conjunctival and corneal scarring present, and in the posterior segment, the severity of retinal scarring affects visual outcome. If the degree of scarring is reduced or eliminated at any stage in its evolution, then the severe complications of cicatrization may be avoided. One area in which wound healing is particularly important is in determining intraocular pressure control after glaucoma filtration surgery. 1,38,45,62 The use of antimetabolites such as mitomycin-C (MMC) and 5-fluorouracil (5FU) as conjunctival antiscarring treatments have revolutionized filtration surgery, particularly in patients known to be at high risk of scarring 47,52,54,86 ; however, these agents highlight the conundrum of the wound healing response: inadequate healing caused by uncontrolled, widespread cell death and apoptosis, 23,49 leading to the formation of thin-walled filtration blebs, wound leakage, hypotony, and infection, 42,74,83 and excessive postoperative scarring results in suboptimal intraocular pressures and surgical failure. In this short review, we summarize the ocular woundhealing response and its modulation with existing and potential therapies, with particular reference to glaucoma filtration surgery.