Conjunctival fibrosis following filtering glaucoma surgery

• Growth factors, structural and biomechanical stimuli interact to drive scarrring following filtering glaucoma surgery.
• Changes in interstitial fluid flow may have a major, yet undefined role in fibrosis following filtering glaucoma surgery.
• A broad spectrum of signaling pathways can be addressed to modulate wound healing.

Despite advances in surgical technique and postoperative care, fibrosis remains the major impediment to a marked reduction of intraocular pressure without the need of additional medication (complete success) following filtering glaucoma surgery. Several aspects specific to filtering surgery may contribute to enhanced fibrosis. Changes in conjunctival tissue structure and composition due to preceding treatments as well as alterations in interstitial fluid flow and content due to aqueous humor efflux may act as important drivers of fibrosis. In light of these pathophysiological considerations, current and possible future strategies to control fibrosis following filtering glaucoma surgery are discussed.