Pharmacological Approaches to Modulate the Scarring Process after Glaucoma Surgery

Glaucoma is an acquired optic neuropathy that results in a characteristic optic nerve head appearance and visual field loss. Reducing the IOP is the only factor that can be modified, and the progression of the disease can be managed through medication, laser treatment, or surgery. Filtering procedures are used when target pressure cannot be obtained with less invasive methods. Nevertheless, these procedures require accurate control of the fibrotic process, which can hamper filtration, thus, negatively affecting the surgical success. This review explores the available and potential pharmacological treatments that modulate the scarring process after glaucoma surgery, analyzing the most critical evidence available in the literature. The modulation of scarring is based on non-steroidal anti-inflammatory drugs (NSAIDs), mitomycin, and 5-fluorouracil. In the long term, the failure rate of filtering surgery is mainly due to the limitations of the current strategies caused by the complexity of the fibrotic process and the pharmacological and toxicological aspects of the drugs that are currently in use. Considering these limitations, new potential treatments were investigated. This review suggests that a better approach to tackle the fibrotic process may be to hit multiple targets, thus increasing the inhibitory potential against excessive scarring following surgery.

Automated summary

Glaucoma is a disease that causes optic nerve damage and visual field loss. Lowering intraocular pressure is the only modifiable factor, and medication, laser treatment, or surgery can manage disease progression. Filtering procedures are used when less invasive methods cannot achieve the target pressure. Accurate control of the fibrotic process during these procedures is crucial for surgical success. This review explores available and potential pharmacological treatments that modulate scarring after glaucoma surgery, highlighting the limitations of current strategies and suggesting the need for multi-target approaches to inhibit excessive scarring.