Current and Future Techniques in Wound Healing Modulation after Glaucoma Filtering Surgeries



Masoumeh B. Masoumpour1, *, M. Hossein Nowroozzadeh1, M. Reza Razeghinejad1, 2
1 Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
2 Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, USA


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© Masoumpour et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Poostchi Eye Research Center, Poostchi Clinic, Zand Street, Shiraz 7134997446, Iran; Tel: +98-71-32302830; Fax: +98-71-32355936; Email: masoumpour@yahoo.com


Abstract

Filtering surgeries are frequently used for controlling intraocular pressure in glaucoma patients. The long-term success of operation is intimately influenced by the process of wound healing at the site of surgery. Indeed, if has not been anticipated and managed accordingly, filtering surgery in high-risk patients could end up in bleb failure. Several strategies have been developed so far to overcome excessive scarring after filtering surgery. The principal step involves meticulous tissue handling and modification of surgical technique, which can minimize the severity of wound healing response at the first place. However, this is usually insufficient, especially in those with high-risk criteria. Thus, several adjuvants have been tried to stifle the exuberant scarring after filtration surgery. Conventionally, corticosteroids and anti-fibrotic agents (including 5-fluorouracil and Mitomycin-C) have been used for over three decades with semi-acceptable outcomes. Blebs and bleb associated complications are catastrophic side effects of anti-fibrotic agents, which occasionally are encountered in a subset of patients. Therefore, research continues to find a safer, yet effective adjuvant for filtering surgery. Recent efforts have primarily focused on selective inhibition of growth factors that promote scarring during wound healing process. Currently, only anti-VEGF agents have gained widespread acceptance to be translated into routine clinical practice. Robust evidence for other agents is still lacking and future confirmative studies are warranted. In this review, we explain the importance of wound healing process during filtering surgery, and describe the conventional as well as potential future adjuvants for filtration surgeries.

Keywords: Anti-fibrotics, filtering surgery, glaucoma, trabeculectomy, wound healing.