Oftalʹmologiâ (Jan 2016)
The modern concept of wound healing in glaucoma surgery
Abstract
Post-operative wound healing is one of the key-factors, defining success of filtrating surgery in late post-operative period. Wound healing is a physiological response directed at tissue structure reconstruction and function restoration, performed by several interacting cellular pathways. Surgical trauma leads to plasma proteins penetration to the filtration zone, as well as coagulation pathway and complement activation. The process of wound healing can be divided into three interconnected stages: inflammation, proliferation and scar remodeling. Inflammation is a protective response to tissue damage, that helps preserve its structure and cellular functions. It is characterized by neutrophil and monocyte arrival at the wound site. Neutrophils phagocytose the wound infecting bacteria and clean the wound site. Macrofages aid wound cleansing, participate in phagocytosis and produce a range of factors, necessary for new tissue formation. Proliferation stage consists of reepithelization and granulation tissue formation, which is accompanied by growth factors release. The growth factors stimulate the extracellular matrix formation and fibroblast proliferation. The last stage of the wound healing process is characterized by extracellular matrix remodeling with wound debridement achieved by a simultaneous synthesis and destruction of certain matrix components, cell differentiation, maturation and apoptosis. Apoptosis disturbance prolongs the fibroblast cell life and promotes excessive scarring. Three growth factors are thought to play a pivotal role in tissue healing and scarring transforming growth factor β, connective tissue growth factor and vascular endothelial growth factor. The article contains a review of their isoforms, role in wound healing and the possibility of their inhibition to alter the process. Matrix metalloproteinases are a protein family that can digest extracellular matrix components. Due to their influence on the tenon’s capsule fibroblasts, they supposedly play a key role in bleb contraction. Metalloproteinases selective inhibition after glaucoma filtration surgery can serve as a preventive measure against postoperative bleb constriction, which in turn enhances the likelihood of postoperative success.
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