Current opportunities for the prevention of excessive scarring after glaucoma surgery using antimetabolites
https://doi.org/10.25700/NJG.2019.03.06
Abstract
Postoperative excessive scarring of the eye tissue at the surgical site is known to be the main reason of postoperative IOP increase. This review presents an analysis of local and foreign literature on the problem of excessive scarring management in glaucoma surgery by means of anti-metabolites (5-fluorouracil and mitomycin C).
It gives an evaluation of their practical efficacy and presents various methods of their application and particular complications. The article also recounts alternatives to anti-metabolites and steroids as well as current means of affecting the process of excessive scarring. The author concludes that currently antimetabolites and, in a lesser degree, steroids present the only viable clinical possibilities of an effective postoperative drug correction of excessive scarring.
About the Authors
M. M. BikbovRussian Federation
Med.Sc.D., Professor, Corresponding Member of the Academy of Sciences of the Republic of Bashkortostan, Director
90 Pushkin street, Ufa, 450008
A. E. Babushkin
Russian Federation
M.D., Ph.D., the head of Scientific and Research Department
90 Pushkin street, Ufa, 450008
O. I. Orenburkina
Russian Federation
M.D., Ph.D., head of Lens Surgery Lab. and Intraocular Correction
90 Pushkin street, Ufa, 450008
References
1. Babushkin A.Je. Trabeculectomy: prevention of excessive postoperative scarring. Tochka zrenija. Vostok-Zapad. 2017; 4:128–131. (In Russ.).
2. Basinskij S.N. The frequency of complications and comparative effectiveness of surgical treatment of primary open-angle glaucoma. RMZh. Klinicheskaja oftal’mologija. 2011; 12(2):67–70. (In Russ.).
3. Bikbov M.M., Babushkin A.Je. Methods of prevention of postoperative scarring of outflow routes. In: Glaukoma. Nacional’noe rukovodstvo [Glaucoma. National leadership]. Eds by E.A. Egorov. Moscow: GJeOTAR-Media; 2013: 624-654. (In Russ.).
4. Bikbov M.M., Babushkin A.Je., Murova L.H., Matjuhina E.N. Results of dispensary observation and polyclinic stage of treatment of patients with primary open-angle glaucoma. Glaukoma. 2012; 4:31-35. (In Russ.).
5. Bikbov M.M., Husnitdinov I.I., Zajdullin I.S. et al. Delivery of mitomycin C and prolongation of its action using the latest hydrogels based on hyaluronic acid and chitosan succinate in antiglaucoma operations Molekuljarnaja medicina. 2017; 15(1):28–32. (In Russ.).
6. Gajer O., Anisimova S.Ju., Anisimov S.I. et al. Cystic changes in bleb after application of cytostatics for antiglaucomatous operations. Experimental study. Nacional’nyj zhurnal glaukoma. 2016; 15(3):3–8. (In Russ.).
7. Germanova V.N., Volzhanin A.V., Zolotarev A.V. et al. Cyclosporine A in the surgical treatment of glaucoma: prospects and opportunities. Nacional’nyj zhurnal glaukoma. 2017; 16 (2):92–100. (In Russ.).
8. Gupalo O.D., Slonimskij S.Ju., Kulik A.V. Comparative analysis of long-term results of repeated antiglaucoma operations. Glaukoma. 2011;1:19–22. (In Russ.).
9. Egorov E.A. et al. Early and long-term results of surgical treatment of glaucoma (results of multicenter study of the CIS countries). RMZh. Klinicheskaja oftal’mologija. 2017; 1:25–34. (In Russ.).
10. Erichev V.P., Gankovskaja L.V., Koval’chuk L.V. et al. Changes in some immunological parameters of lacrimal fluid with excessive scarring after antiglaucomatous operations in patients with primary openangle glaucoma. Vestnik oftal’mologii. 2010; 126 (3):25-29. (In Russ.).
11. Erichev V.P., Hachatrjan G.K. Glycosaminoglycan matrix in the prevention of conjunctival scleral scarring with sinustrabeculectomy. Nacional’nyj zhurnal glaukoma. 2018; 17(1):37-42. (In Russ.).
12. Zherdeckij A.S., Artamonov V.P., Seleznev A.V., Parshutina M.S. Experimental and clinical rationale for the use of 5-fluorouracil in open-angle glaucoma surgery. Glaukoma. 2005; 1:25–28. (In Russ.).
13. Zhigal’skaja T.A., Krivosheina O.I. The use of cytostatics in the surgery of refractory glaucoma. Rossijskij oftal’mologicheskij zhurnal. 2018; 11(3)71-75. (In Russ.).
14. Kurysheva N.I., Marnyh S.A., Kizeev M.V. et al. Intrascleral implantation of amnion in prevention of excessive scarring after antiglaucomatous operations (clinical and morphological study). Glaukoma. 2005; 1:29–35. (In Russ.).
15. Lebedev O.I., Javorskij A.E., Stoljarov G.M. et al. Prevention of excessive scarring with non-penetrating deep sclerectomy. Glaukoma. 2011; 1:32–36. (In Russ.).
16. Mamikonjan V.R., Petrov S.Ju., Safonova D.M. VEGF inhibitors in glaucoma surgery. Oftal’mologicheskie vedomosti. 2016; 9(1):47–55. (In Russ.).
17. Petrov S.Ju., Antonov A.A., Vostruhin S.V. et al. Activation of a filtration cushion in the early period after fistulizing surgery. Oftal’mologija. 2014; 11(3):80–88. (In Russ.).
18. Petrov S.Ju., Antonov A.A., Makarova A.S. et al. Possibilities of prolongation of the hypotensive effect of trabeculectomy. Vestnik oftal’mologii. 2015; (1):75–81. (In Russ.).
19. Petrov S.Ju., Lovpache Dzh.N., Loskutov I.A., Safonova D.M. The influence of local antihypertensive therapy on the condition of the anterior eye tissue and the outcome of fistulatory glaucoma surgery. Oftal’mologicheskie vedomosti. 2017; 10 (4):41–47. (In Russ.).
20. Petrov S.Ju. The modern concept of struggle against excess scarring after glaucoma surgery fistulotomy. Risk factors and antimetabolites drugs. Oftal’mologija. 2017; 14(1):5–11. (In Russ.).
21. Petrov S.Ju. Modern concept of fight against excessive scarring after fistulizing glaucoma surgery. Anti-inflammatory drugs and new trends. Oftal’mologija. 2017; 14(2):99–105. (In Russ.).
22. Chervjakov A.Ju., Bessmertnyj A.M. Surgical tactics for hypertension after fistulizing operations. Glaukoma. 2002; 1:39–42. (In Russ.).
23. Shmyreva V.F., Mostovoj E.N. On the use of cytostatic therapy with 5-photoruracil in glaucoma surgery. Vestnik oftal’mologii. 2004; 3:7–10. (In Russ.).
24. Shmyreva V.F., Petrov S.Ju., Makarova A.S. The reasons for the decrease in the remote hypotensive efficacy of antiglaucomatous operations and the possibility of its increase. Glaukoma. 2010; 2:43–49. (In Russ.).
25. Baudouin C., Hamard P., Liang H. et al. Conjunctival epithelial cell expressions of interleukins and inflammatory markers in glaucoma patients treated over the long term. Ophthalmology. 2004; 111(12): 2186–2192.
26. Bikbov M., Fayzrakhmanov R., Salavatova V.,Kazakbaeva G. et al. Intraocular pressure and its associations in a Russian population: The Ural Eye and Medical Study. Invest Ophthalmol Vis Sci. 2018; 59(9):2722-2733.
27. Broadwey D.C., Chang L.P. Trabeculectomy, risk factors for failure and the preoperative state of the conjunctiva. Glaucoma. 2001; 10 (3): 237–249.
28. Casson R., Rahman R., Salmon J.F. Long-term results and complications of trabeculectomy augmented with low dose mitomycin C in patients at risk for filtration failure. Brit Ophthalmol. 2001; 85(6):686–688.
29. Cheng J.W., Xi G.L., Wei R.L. et al. Efficacy and tolerability of nonpenetrating filtering surgery in the treatment of open-angle glaucoma: a meta-analysis. Ophthalmologica. 2010; 224(3):138-146.
30. Chua B.E., Nguyen D.Q., Qin Q. et al. Bleb vascularity following post- trabeculectomy subconjunctival bevacizumab: a pilot study. Clin Exper Ophthalmol. 2012; 40(8): 773-779.
31. Fakhraie G., Lopes J.F., Spaeth G.L. et al. Effects of postoperative cyclosporine ophthalmic emulsion 0,05% (Restasis) following glaucoma surgery. Clin Exper Ophthalmol. 2009; 37(9):842–848.
32. Fontana H., Nouri-Mahdavi K., Lumba J. et al. Trabeculectomy with mitomycin C: outcomes and risk factors for failure in phakic openangle glaucoma. Ophthalmology. 2006; 113(6):930-936.
33. Grehn F., Hollo G., Khaw P. et al. Factors affecting the outcome of trabeculectomy: an analysis based on combined data from two phases III stadies of antybody to transforming growth factor beta 2, CAT-152. Ophthalmology. 2007; 114(10): 1831-1838.
34. Gutierrez-Ortiz C., Cabarga C., Teus M.A. Prospective evalution of preoperative factors associated with succeassful mitomycin C needling of failed filtracion blebs. Glaucoma. 2006; 15(2):98–102.
35. Heatley G., Kiland J., Faha B. et al. Gene therapy using p21 WAF-1/ Cip-1 to modulate wound healing after glaucoma trabeculectomy surgery in a primate model of ocular hypertension. Gene Ther. 2004; 11: 949–955.
36. How A., Chua J.L., Charlton A. et al. Combined treatment with bevacizumab and 5-fluorouracil attenuates the postoperative scarring response after experimental glaucoma filtration surgery. Invest Ophthalmol Vis Sci. 2010; 51(2): 928–932.
37. Kahook M.Y. Bleb morphology and vascularity after trabeculectomy with intravitreal ranibizumab: A pilot study. Am J Ophthalmol. 2010; 150(3):399–403.
38. Kim H.Y., Egbert P.R., Singh K. Long-term comparison of primary trabeculectomy with 5-fluorouracil versus mitomycin C in West Africa. Glaucoma. 2008; 2(4):266–270.
39. Khairy H.F., Elsawey V.F. Trabeculectomy with mitomycin C versus trabeculectomy with amniotic membrane transplant: A medium-term randomized, controlled trial. Glaucoma. 2015; 2(7):556–559.
40. Khaw P.T., Doyle J.W., Sherwood M.B. et al. Prolonged localized tissue effects from 5-minute exposures to fluorouracil and mitomycin C. Arch Ophthalmol. 1993; 111(2):263–267.
41. Kozobolis V.P., Christodoulakis E.V., Tzanakis N. et al. Primary deep sclerectomy versus primary deep sclerectomy with the use of mitomycin C in primary open-angle glaucoma. Glaucoma. 2002; 11:287-293.
42. Mathalone N., Marmor S., Rahat M.A. et al. MMP expression in leaking filtering blebs and tears after glaucoma filtering surgery. Graefes Arch Clin Exp Ophthlmol. 2011; 249(7):1047–1055.
43. Rehman S.U., Amoaku W.M., Doran R.M. et al. Randomized controlled clinical trial of beta irradiation as an adjunct to trabeculectomy in open-fngle glaucoma. Ophthalmology. 2002; 109:3022–369.
44. Sayyod F., Belmekki M., Helal M. Simultaneous subconjunctival and subscleral mitomycin C application in trabeculectomy. Ophthalmology. 2000; 107(2):298–301.
45. Singh K., Mehta K., Shaikh N.M. et al. Trabeculectomy with intraoperative mitomycin C versus 5-fluorouracil. Prospective randomized clinical trial. Ophthalmology. 2000; 107(12):2305–2309.
46. Shetty R.K., Warluft L., Moster M.R. Slit-lamp needle revision of failed filtering blebs using high-dose mitomycin C. Glaucoma. 2005; 14 (1):52–56.
47. Song A., Scott I.U., Flynn H.W. et al. Delayed-onset bleb-associated endophtalmitis clinical features and visual acuity outcomes. Ophthalmology. 2002; 109(5):985–991.
48. Turaçli M.E., Gunduz K., Aktan G., Sencer H. Topical cyclosporine as a possible new antimetabolite in trabeculectomy. Ophthalmic Surg Lasers. 2009; 27(6):438–444.
49. Vandewalle E. et al. Intracameral bevacizumab as an adjnct to trabeculectomy: a 1-year prospective randomized study. Brit J Ophthalmol. 2013; 98(1):98–102.
50. Vasudevan S.K. Intracameral bevacizumab as an adjnct to trabeculectomy: a 1-year prospective randomized study. Invest Ophthalmol Vis Sci. 2009; 50(13):456-466.
Review
For citations:
Bikbov M.M., Babushkin A.E., Orenburkina O.I. Current opportunities for the prevention of excessive scarring after glaucoma surgery using antimetabolites. National Journal glaucoma. 2019;18(3):55-60. (In Russ.) https://doi.org/10.25700/NJG.2019.03.06