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Br J Ophthalmol 2002;86:490-492 doi:10.1136/bjo.86.5.490
  • Editorial

Gene therapy: new “magic bullets” to prevent ocular scarring

  1. P T Khaw,
  2. A D Cambrey,
  3. G A Limb,
  4. J T Daniels
  1. Wound Healing Research Unit, Epithelial Repair and Regeneration Group, Divisions of Pathology, Cell Biology and Glaucoma, Moorfields Eye Hospital and the Institute of Ophthalmology, University College London, UK
  1. Correspondence to: P T Khaw, Wound Healing Research Unit, Glaucoma Unit and Divisions of Pathology and Cell Biology, Moorfields Eye Hospital and Institute of Ophthalmology, Bath Street, London EC1V 9EL, UK; p.khaw{at}ucl.ac.uk

    Will the advances in modern molecular biology open doors to new therapies?

    The processes involved in ocular scarring play a part in either the pathogenesis or failure of treatment of most of the major blinding diseases in the world. These processes include capsular opacification and contraction after cataract surgery. Although posterior capsular opacification is relatively easily treated with laser, this biological process poses great problems following cataract surgery in developing countries, and will inhibit the development of a true accommodating lens replacement. The retinal scarring that occurs in proliferative vitreoretinopathy (PVR) and macular degeneration is also an important example of the blinding scarring process.

    The scarring process following glaucoma filtration surgery is one of the best examples of the importance of being able to control healing in virtually all patients having a particular procedure. Recent data from the NIH advanced glaucoma intervention study (AGIS)1 have shown that individuals with the lowest intraocular pressures (average 12.3 mm Hg) had virtually no overall glaucomatous progression over nearly a decade. The healing response after surgery is the main long term determinant of long term intraocular pressure. Therefore, if we are able to control the healing response in all patients after glaucoma surgery, it offers us the tantalising prospect of minimal or no disease progression in the vast majority of our glaucoma patients, even those with advanced disease.

    The advent of anticancer agents has revolutionised glaucoma surgery in patients who have a high risk of failure following surgery. …

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