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Prolonged antiscarring effects of ilomastat and MMC after experimental glaucoma filtration surgery

Tina T L Wong1, Anna L Mead, Peng T Khaw

  • 1Ocular Repair and Regeneration Biology Unit, Institute of Ophthalmology, London, UK. tina.wong@ucl.ac.uk

Investigative Ophthalmology & Visual Science
|May 26, 2005
PubMed
Abstract

Insights

Ilomastat treatment effectively reduced scarring and prolonged bleb survival after glaucoma filtration surgery, showing comparable results to mitomycin-C (MMC). This matrix metalloproteinase inhibitor offers a promising, potentially safer alternative for preventing glaucoma surgery failure.

Area of Science:

  • Ophthalmology
  • Surgical Innovation
  • Pharmacology

Background:

  • Glaucoma filtration surgery (GFS) success is often limited by postoperative scarring.
  • Controlling intraocular pressure (IOP) is crucial for preventing glaucoma progression.
  • Existing antifibrotic agents like mitomycin-C (MMC) have potential side effects.

Purpose of the Study:

  • To evaluate the long-term antiscarring efficacy of ilomastat following experimental GFS.
  • To compare ilomastat's effect on bleb survival and IOP with MMC and a vehicle control.
  • To assess the histological impact of ilomastat on conjunctival tissue post-surgery.

Main Methods:

  • A randomized, prospective, masked-observer study involving 21 New Zealand White rabbits undergoing modified GFS.
  • Animals received either intraoperative MMC, postoperative ilomastat, or phosphate-buffered saline (PBS) vehicle.
  • Bleb morphology, IOP, and histological scarring were assessed 60 days post-surgery.

Main Results:

  • Ilomastat significantly improved surgical outcomes and prolonged bleb survival compared to vehicle (P < 0.0163).
  • Bleb survival with ilomastat was comparable to the MMC group, with mean failure days of 46.2 (ilomastat) vs. 51.3 (MMC) vs. 16 (vehicle).
  • Ilomastat and MMC showed minimal scarring; ilomastat resulted in normal conjunctival morphology, unlike MMC-induced hypocellularity and fibrosis.

Conclusions:

  • Ilomastat effectively prolongs bleb survival and maintains IOP after GFS.
  • Matrix metalloproteinase (MMP) inhibition via ilomastat presents a potentially safer method for controlling IOP and preventing glaucoma surgery failure.
  • Ilomastat may serve as an effective adjuvant therapy when MMC alone is insufficient.

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