Current and future prospects for the prevention of ocular fibrosis

Significant advances have been made in developing new treatments and refining existing treatments for the prevention of scarring after disease, trauma, or surgical prevention. The advent of new technologies in addition to traditional chemical drugs such as dendrimers, antibodies, aptamers, ribozymes, gene therapy with viral vectors, and RNA interference, opens the door to a whole new generation of therapies to prevent fibrosis in the eye. The ability to control fibrotic processes in the eye offers many tantalizing prospects, including prevention of corneal blindness from scarring to "20/5 vision" with perfect corneal wound healing after wavefront refractive surgery prevention of PCO to fully accommodative lens implants, 100% success of glaucoma surgery with pressure at approximately 10 mmHg associated with < 5% progression over a decade, to no failure of retinal detachment surgery and minimal visual loss from AMD. Finally, most exciting is the prospect that neutralizing the fibrotic response to disease and injury will allow us to revert to the "fetal" mode when regeneration is the normal process, such as shown in the recent report that demonstrated that induction of bcl-2 gene expression together with downregulation of gliosis results in axonal regeneration in mice.