Impact of anticancer drugs on human Tenon's fibroblast proliferation: implications for glaucoma surgery

Elevated intraocular pressure (IOP) is a major risk factor for glaucoma and the primary target of current therapies. When IOP-lowering drugs are insufficient, surgical intervention may be required; however, conjunctival and subconjunctival scarring often limits long-term success. Although intraoperative and postoperative antimetabolite treatments help preserve surgical outcomes, they are associated with ocular side effects. This study investigated the effects of selected anticancer drugs on the proliferation of human Tenon's fibroblasts (HTFs), key mediators of postoperative scarring.

Primary HTFs were isolated from explants obtained during glaucoma surgery and characterised by immunofluorescence. The cytotoxic effects of candidate drugs were assessed using the MTT and LDH assays, while HTF migration and proliferation were evaluated by wound-healing assays. Additional cytotoxicity testing was performed on primary human trabecular meshwork cells (HTMCs) to assess ocular safety.

Under the experimental conditions used, HTF proliferation, rather than migration, was the main driver of wound closure. Among the drugs tested, pemigatinib and sorafenib significantly slowed wound closure. Pemigatinib showed no cytotoxicity in either HTFs or HTMCs, whereas sorafenib induced a moderate (28%) cytotoxic effect in HTMCs.

Pemigatinib and sorafenib, two Food and Drug Administration-approved anticancer agents, effectively reduced HTF proliferation, with pemigatinib showing a more favourable safety profile. These findings identify selective fibroblast growth factor receptor (FGFR) inhibition as a promising strategy for modulating postoperative fibrosis and support further preclinical studies to evaluate the safety and efficacy of FGFR inhibitors as potential adjuncts in glaucoma surgery.