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Modulation of Wound Healing in Glaucoma Surgery
Grehn F., Karasheva G., Wimmer I.,
Bayerische Julius-Maximilians-Universität Würzburg, Universitäts-Augenklinik (Würzburg)
Scarring of the filtering bleb is a hitherto underestimated problem of glaucoma surgery. About 60 % of operated cases are under medical treatment 1 year after glaucoma surgery, a large proportion already after few weeks. Glaucoma surgery, however, can only be defined successful if the target pressure is reached without glaucoma medication. Therefore, antfibrosis agents are used in glaucoma surgery in addition to steroid application. The slit lamp morphology of the filtering bleb (vascularity, cork-screw vessels, encapsulation, microcysts) is a better guide for indication of antifibrotic agents than intraocular pressure. Present recommendations: 1. Steroids are given as eye-drops 5 times per day or hourly tapering off over several weeks. 2. In eyes with previous surgery, mitomycin C is recommended in a 0.2 mg/ml concentration soaked in a 8x8 mm sponge topically applied for 3 min at the time of surgery. 3. 5-Fluorouracil injections (5 mg) are given postoperatively if excessive wound healing occurs. Needling with subsequent 5-FU injections is indicated in encapsulated blebs. With these measures, the success rate can be doubled. Future developments: Because of the side effects of MMC and 5-FU, alternatives are being developed. 1. Anti-TGFß2 antibodies act against the this cytokine which plays a major role in wound healing of filtering blebs. A multicenter randomized prospective European study is underway to test the efficacy of these antibodies when used in glaucoma surgery. Antisense nucleotides and receptor antagonists are also candidates for future research. 2. Suramine inhibits various cytokines. 3. Photodynamic therapy is a promising method which allows selective control of fibroblast activity. These developments will probably help to better control wound healing of glaucoma surgery in the near future.