Antifibrotics and wound healing in glaucoma surgery.
When medical and laser therapy fail to control intraocular pressure, glaucoma filtration surgery needs to be performed. Glaucoma surgery is unique in that its success is linked to interruption of the wound-healing response in order to maintain patency of the new filtration pathway. In this article we will review the wound-healing pathway and the pharmacologic interventions that have been employed clinically and experimentally to interrupt wound healing, particularly steroids and the antifibrotic agents 5-fluorouracil and mitomycin C. A review of the published literature looking at use of these agents to enhance success as well as the associated complications are presented, critiqued, and interpreted in order to put the studies in proper perspective. Future directions and recommendations regarding use of these agents are available and an introduction to newer wound modulating agents such as anti-transforming growth factor beta 2 is presented.
Lama
Paul J
PJ
Glaucoma Division, New Jersey Medical School, Newark 07103, USA.
Fechtner
Robert D
RD
D005355:Fibrosis / Q000188:drug therapy; D005472:Fluorouracil / Q000627:therapeutic use*; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007429:Intraocular Pressure; D016685:Mitomycin / Q000627:therapeutic use*; D014130:Trabeculectomy; D016212:Transforming Growth Factor beta / Q000627:therapeutic use; D053781:Transforming Growth Factor beta2; D014945:Wound Healing / Q000187:drug effects* / Q000502:physiology
D007166:Immunosuppressive Agents; C509041:TGFB2 protein, human; D016212:Transforming Growth Factor beta; D053781:Transforming Growth Factor beta2; D016685:Mitomycin; D005472:Fluorouracil