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Review
. 2024 Apr 30;11(5):446.
doi: 10.3390/bioengineering11050446.

Wound Modulations in Glaucoma Surgery: A Systematic Review

Bhoomi Dave  1   2 , Monica Patel  1 , Sruthi Suresh  1 , Mahija Ginjupalli  1 , Arvind Surya  1 , Mohannad Albdour  3 , Karanjit S Kooner  1   4
Affiliations
Review

Wound Modulations in Glaucoma Surgery: A Systematic Review

Bhoomi Dave et al. Bioengineering (Basel). .

Abstract

Excessive fibrosis and resultant poor control of intraocular pressure (IOP) reduce the efficacy of glaucoma surgeries. Historically, corticosteroids and anti-fibrotic agents, such as mitomycin C (MMC) and 5-fluorouracil (5-FU), have been used to mitigate post-surgical fibrosis, but these have unpredictable outcomes. Therefore, there is a need to develop novel treatments which provide increased effectiveness and specificity. This review aims to provide insight into the pathophysiology behind wound healing in glaucoma surgery, as well as the current and promising future wound healing agents that are less toxic and may provide better IOP control.

Keywords: anti-LOXL2 monoclonal Ab; anti-vascular endothelial growth factors; antifibrotic agents; cytokine inhibitors; glaucoma surgery; growth factor inhibitors; integrin inhibitors; wound healing.

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Conflict of interest statement

The authors declare no financial disclosures or conflicts of interest in this work.

Figures

Figure 2
Figure 2
PRISMA Flowchart illustrating the selection process for this systematic review.
Figure 1
Figure 1
(A) Cross-section of an eye illustrating the AH flow dynamics. AH is formed by the ciliary body and flows through the pupil into the anterior chamber (AC). The drainage of AH is mainly via the conventional [TM, SC, and EV] pathway and the non-conventional [US-UV] pathway. (B) Higher magnification of (A). Red arrow #1 denotes AH flow from the trabecular meshwork through the Schlemm’s canal, collector channels, aqueous veins, and into the episcleral veins for drainage into the bloodstream. The uveoscleral pathway (red arrow #2) shows AH flowing directly through the ciliary muscle to the suprachoroidal space, and out through the sclera, eventually reaching general circulation.
Figure 3
Figure 3
An overview of the chronology seen in the general healthy wound healing process in the eye: From left to right, this figure shows (1) hemostasis, (2) inflammation, (3) proliferation, and (4) remodeling.
Figure 4
Figure 4
Flow diagram showing two distinct healing outcomes of fibrosis: minimal or excessive fibrosis after glaucoma surgery, as well as potential drug targets.
Figure 5
Figure 5
(A–C). Steps of trabeculectomy: conjunctival incision, superficial scleral flap, removal of trabecular meshwork/SC block, and iris (iridectomy). (C) shows an ultrasound biomicroscopy (UBM) after trabeculectomy.
Figure 6
Figure 6
A cystic bleb at the limbus and a diffuse bleb formed after trabeculectomy.
Figure 7
Figure 7
(A) A large, encysted bleb superolaterally in the left eye, formed after the insertion of a GDD. (B) Ultrasound biomicroscopy of the anterior segment shows the tip of the GDD in the anterior chamber. Posteriorly, the GDD tube is seen laying on the sclera, and a large filtering bleb is clearly visible.
Figure 8
Figure 8
The mechanism of action and effects of mitomycin C.
Figure 9
Figure 9
The mechanism of action and effects of 5-fluorouracil.
Figure 10
Figure 10
A schematic demonstrating nanotechnology-mediated drug delivery involving an antifibrotic drug encapsulated in a nanoparticle.
See this image and copyright information in PMC

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Grants and funding

This research was partly funded by an unrestricted challenge grant from Research to Prevent Blindness, New York, NY, USA.

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