Postoperative fibrosis suppression

The use of antimetabolites to modulate wound healing post-trabeculectomy has been a major advance in glaucoma filtering surgery. Initially, 5-fluorouracil and, more recently, mitomycin C, have been used to dramatically improve success rates in patients at high risk for trabeculectomy failure, reducing the need for postoperative glaucoma medications. However, the use of antimetabolites has been accompanied by an increased risk of complications, including early and late bleb leaks, hypotony, maculopathy, and endophthalmitis. An alternative treatment that could be applied after surgery to rescue those blebs that appear at increased risk to fail would be valuable, especially if it would obviate the need for mitomycin C.

Fuller et al’s study in this issue of the BJO (p 1352) highlights a different approach to fibrosis suppression post-trabeculectomy. Their regimen involves the use of three agents taken orally: …