Current trends in the management of reparative processes after glaucoma surgery: A literature review (Part 2)

Fibrotic remodeling of the filtration area after glaucoma surgery remains a major cause of surgical failure, driving the development of multi-tiered preventive strategies. Purpose. To summarize and critically appraise contemporary strategies for modulating the wound-healing response after glaucoma surgery—encompassing surgical approaches, physical and biological barrier technologies, nanostructured surface coatings, and geneand cell-based therapies—to prevent and control postoperative fibrosis. Materials and methods. This review draws on 30 peer-reviewed articles published within the past decade and indexed in PubMed, Scopus, and Web of Science. The analysis focused on studies addressing reparative mechanisms following glaucoma surgery, fibrosis prevention strategies, and emerging biomedical technologies. Results. Analysis of modern surgical optimization techniques shows that the use of adjustable sutures, Ahmed and Baerveldt drainage devices, and minimally invasive implants (iStent, Hydrus, XEN Gel Stent) helps reduce inflammation, ensure uniform aqueous humor outflow, and suppress fibroblast activity. Minimally invasive technologies demonstrate favorable clinical outcomes in patients with early-stage glaucoma, whereas drainage devices provide more sustained intraocular pressure reduction in patients at high risk of fibrosis. Anti-adhesive membranes and nanostructured coatings based on titanium or silver effectively prevent cellular adhesion and exhibit additional anti-inflammatory and antibacterial properties. Gene therapy and mesenchymal stem cells show high potential in suppressing fibrosis at the preclinical level but require further investigation to confirm safety and efficacy. The most clinically applicable developments include antiproliferative gels and implantable physical barriers that provide long-term protection of the filtration area after surgery. Conclusion. Modern technologies for preventing postoperative fibrosis in glaucoma surgery represent varying degrees of translational maturity—from clinically implemented methods to those still undergoing preclinical validation. The most evidence-based options for clinical use are minimally invasive drainage devices, anti-adhesive coatings, and physical barriers, whereas geneand cell-based therapies require additional proof of efficacy and safety.

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