Wound healing modulation after glaucoma surgery

Abstract

Recent developments in molecular and cell biology have made a major impact on our understanding of the wound healing process and its modification. In this article, the spectrum of therapies that are either currently available or have potential application as modulators of the scarring response following glaucoma surgery are reviewed. Refinement of existing antimetabolite regimens can improve surgical results, especially in carefully selected patient groups. However, the most promising new approach appears to be using molecular-based therapies, such as fully human neutralizing monoclonal antibodies, designed to target specific molecules in the scarring response. Such strategies ultimately offer the potential of safer, more specific, focal, and titratable treatment, with far-reaching clinical applications.

Bevacizumab Inhibits Angiogenesis and Inflammation in Rat Filtration Surgery Model

“…In this paper, we found that Bevacizumab not only effects VEGF and its receptors expression but also reduces TGFb. TGFb is a key mediator of inflammation and critically involved in postoperative scarring [26,27]. Interestingly, recent study showed that VEGF induced TGF-b1 expression and myofibroblast transformation after glaucoma surgery.…”

Direct Effects of Bevacizumab on Rat Conjunctival Fibroblast

“…Meanwhile, expression of TGFb1 and TGFb2 in fibroblast was also inhibited by Bevacizumab. It has been reported that VEGF had a critical role in TGF-b1 production and may result in excessive fibrosis by activating myofibroblast transformation in various diseases [21][22][23][24]. Especially, VEGF was found that it could induce TGF-b1 in the subconjunctival tissue, resulting in excessive subconjunctival fibrosis after trabeculectomy [25].…”

Laser-grid trabeculectomy in rabbits: an experimental in-vivo study

“…The main problem with all filtering procedures remains subconjunctival scarring caused by increased postoperative fibroblast activity [1,3,21,25]. This phenomenon occurs regularly after ab-externo laser sclerostomy, regardless of surgical modifications, the laser wavelength, and total energy used [7,8,12,15,16].…”

“…However, our surgical modification does not solve the key problem of episcleral scarring, as subconjunctival drainage still occurs. As the rabbit eye usually shows accelerated scar formation after any filtering procedure, we performed a short-term study of only 14 days with a fixed ending, including the characteristic period of bleb closure [3,25].…”