Overview of cicatricial modulators in glaucoma fistulizing surgery

Area of Science:

• Ophthalmology
• Surgical Innovation
• Glaucoma Treatment

Background:

• Trabeculectomy is a primary glaucoma surgery, but its postoperative phase requires careful management to prevent complications like excessive filtration or scarring.
• Current healing modulators, mitomycin C (MMC) and 5-fluorouracil, are effective but associated with potential adverse effects.

Purpose of the Study:

• To systematically review alternative healing modulators for trabeculectomy beyond the commonly used mitomycin C (MMC) and 5-fluorouracil.
• To identify safer and equally effective options for managing postoperative healing in glaucoma surgery.

Main Methods:

• A systematic review of scientific literature was conducted.
• Publications were sourced from PubMed and SciELO databases, covering research from 1972 to 2019.
• A total of 31 different substances and methods were analyzed.

Main Results:

• Several alternatives, including anti-VEGF agents, glucocorticoids, and betatherapy, did not demonstrate statistically superior outcomes compared to MMC.
• The enzyme α5β1-integrin and Ologen® showed comparable efficacy and safety profiles to MMC.
• Emerging technologies focus on enhancing cellular-level communication for antifibrotic effects.

Conclusions:

• While some alternatives match MMC's efficacy and safety, further investigation is required to find options with reduced side effects.
• Advanced technologies targeting cellular communication represent a promising future direction for antifibrotic therapies in glaucoma surgery.
• Continued research into novel healing modulators is crucial for improving trabeculectomy outcomes.