Abstract
ABSTRACTGlaucoma filtration surgery is regularly performed for the treatment of glaucoma and trabeculectomy is often regarded as the ‘gold standard' glaucoma operation. The biggest risk of failure of the operation is bleb scarring. The advent of anti-fibrotic agents, such as mitomycin C (MMC) and 5-fluorouracil (5FU) has vastly prolonged the longevity of the bleb, but concerns remain regarding the potential increase in postoperative complications. More selective therapeutic targets have therefore been explored. One of these is vascular endothelial growth factor (VEGF) inhibition. Vascular endothelial growth factor inhi bition has a role not only in sub conjunctival angiogenesis inhi bition but also it has direct anti-fibrotic properties. Newer phar macological compounds and materials have also been developed in recent years in attempt to modulate the wound healing in different ways after glaucoma surgery. These include physical barriers to scarring and vehicles for sustained release of pharmacological agents, and early promising results have been demonstrated. This two-part review will provide a discussion of the application of anti-fibrotic agents in glaucoma filtration surgery and evaluate the newer agents that have been developed.How to cite this article: Fan Gaskin JC, Nguyen DQ, Ang GS, O'Connor J, Crowston JG. Wound Healing Modulation in Glaucoma Filtration Surgery–Conventional Practices and New Pers pectives: The Role of Antifibrotic Agents (Part I). J Curr Glaucoma Pract 2014;8(2):37-45.
Highlights
It has long been recognised that fibrosis of the filtration site is one of the main reasons for primary failure of glaucoma filtering surgery
The first phase is an immediate inflammatory response that occurs in the initial postoperative days. This phase is characterized by recruitment of inflammatory cells, cytokines and growth factors, triggering the onset of the second phase, proli feration and tissue reparation, which commences in the early postoperative days and can continue into the second or third postoperative months
The Fluorouracil Filtering Surgery Study Group observed that in patients deemed to be at higher risk of bleb failure, such as those with previous cataract surgery or failed filtration surgery, trabeculectomy is more likely to have long- term success if repeated postoperative subconjunctival 5FU injections are administered.[69]
Summary
It has long been recognised that fibrosis of the filtration site is one of the main reasons for primary failure of glaucoma filtering surgery. The Fluorouracil Filtering Surgery Study Group observed that in patients deemed to be at higher risk of bleb failure, such as those with previous cataract surgery or failed filtration surgery, trabeculectomy is more likely to have long- term success if repeated postoperative subconjunctival 5FU injections are administered.[69] The 5-year cumulative success rate for eyes with a history of cataract surgery was 48% in the 5FU group and 23% in the control group (p < 0.001). WuDunn et al conducted a similar study by randomizing patients (115 eyes of 103 subjects) without prior intraocular surgery to intraoperative 5FU or 0.2 mg/ml MMC in trabeculectomy and their results showed no significant difference between the two groups in terms of success or complication rates This was consistent both at 12 months and long-term follow-up.[64,77]. Chitosan nanoparticles are stable in human tissue and are theoretically safe but the safety and efficacy of this new system are yet to be tested in laboratory and clinical trials
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