Improving patient outcomes following glaucoma surgery: state of the art and future perspectives

Abstract

Tine Van Bergen,1 Sarah Van de Velde,1 Evelien Vandewalle,3 Lieve Moons,2 Ingeborg Stalmans1,31Laboratory of Ophthalmology, KU Leuven, 2Unit Animal Physiology and Neurobiology, KU Leuven, 3Department of Ophthalmology, University Hospitals Leuven, Leuven, BelgiumAbstract: Of all the treatments currently used to lower intraocular pressure in glaucoma patients, filtration surgery is known to be the most effective. However, in a significant percentage of cases, the constructed channel closes due to excessive scar formation, resulting in surgical failure. The process of postoperative wound healing is characterized by the coagulative and inflammatory phase, followed by the proliferative and repair phase, and finally the remodeling phase. Perioperative antimitotic agents, such as mitomycin C and 5-fluorouracil, are known to modulate the process of wound healing and to improve surgical outcome, but they carry a risk of vision-threatening complications. New alternative strategies to prevent filtration failure, such as inhibition of transforming growth factor-β, vascular endothelial growth factor, and placental growth factor, have shown promising results in the improvement of surgical success. However, it remains necessary to broaden the therapeutic approach by focusing on combined therapies and on extended drug delivery.Keywords: glaucoma filtration surgery, filtration failure, wound healing, wound modulating agents