New developments in the pharmacological modulation of wound healing after glaucoma filtration surgery

Despite the advent of many new devices for glaucoma surgery, scarring is the main cause of suboptimal pressure control and surgical failure in all forms of surgery. The cytotoxic antimetabolites, 5-flurouracil and mitomycin C both prolong success but with the increased risk of blinding complications. A greater understanding of the cellular mechanisms of the wound healing response has led to the identification and modulation of potential therapeutic targets. These include transforming factor β, inflammatory mediators, the acute phase protein serum amyloid P, vascular endothelial growth factor and the matrix metallaproteinases. While optimal drug delivery is still a major challenge, modulating these effects either directly or through downstream signalling promises to yield anti-scarring efficacy, while minimising side effects.

184Highlights► Scarring is the major cause of surgical failure for glaucoma surgery including new devices. ► Current anti-scarring agents have an increased risk of blinding complications. ► New approaches to the inhibition of different pathways may yield efficacious safer alternatives.