Current trends in the management of reparative processes after glaucoma surgery: A literature review (Part 1)
Abstract
Background. Glaucoma is a chronic progressive disease leading to significant vision loss and remains one of the leading causes of blindness worldwide. Among the most effective treatment options is surgical intervention aimed at lowering intraocular pressure (IOP) by creating or restoring aqueous humor outflow pathways. However, the major challenge of glaucoma surgery is postoperative fibrosis, which reduces surgical success. Purpose. To systematize current understanding of the wound-healing response following glaucoma surgery and to identify key strategies for controlling scarring. Materials and methods. The first part of the review includes scientific articles published over the past 10 years, focusing on wound-healing mechanisms in glaucoma surgery, methods for preventing fibrotic complications, and promising therapeutic strategies. A literature search was conducted in PubMed, Scopus, and Web of Science databases, yielding 59 articles for analysis. Results. The analysis showed that the main drivers of postoperative fibrosis after glaucoma surgery are the activation of inflammatory pathways, overproduction of extracellular matrix, and immune dysregulation. Antimetabolites remain the gold standard for preventing postoperative fibrosis. Mitomycin-C (MMC) significantly improves trabeculectomy outcomes, but at high doses it may induce dystrophic and necrotic changes in ocular surface tissues. By contrast, 5-fluorouracil (5-FU) has a safer profile but requires serial administration and is less effective. Combining low doses of antimetabolites with an amniotic membrane or hydrogel carriers reduces toxicity and prolongs drug action. Targeted inhibition of growth factors—including angiogenesis inhibitors, pirfenidone, and SB-431542—demonstrates high therapeutic potential. Conclusion. Effective management of reparative processes after glaucoma surgery requires a multi-tiered approach, encompassing inflammation reduction, modulation of cellular signaling pathways, and controlled extracellular matrix remodeling. Despite progress, further research is needed to optimize combination therapies, minimize adverse effects, and implement advanced biotechnological strategies for greater precision in clinical practice.