Overview of cicatricial modulators in glaucoma fistulizing surgery
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REVIEW
Overview of cicatricial modulators in glaucoma fistulizing surgery Camille Moura de Oliveira
. Juliana de Lucena Martins Ferreira
Received: 12 February 2020 / Accepted: 25 May 2020 Ó Springer Nature B.V. 2020
Abstract Introduction Trabeculectomy is the most commonly performed surgery for the definitive treatment of glaucoma. Despite its high resolvability, the postoperative period requires high caution so that excessive filtration or scarring does not occur. This paper aimed to research alternative options to those most used as healing modulators, mitomycin C (MMC) and 5-fluorouracil, commonly associated with complications. Methods This systematic review used the PubMed and SciELO databases, covering publications from 1972 to 2019. Results A total of 31 substances and methods were analyzed. Conclusion Some, such as anti-VEGF, glucocorticoids and betatherapy, did not show results statistically superior to those of MMC. Others, such as the enzyme a5b1-integrin and OlogenÒ, demonstrated efficacy and safety at least similar to that of this drug. In conclusion, further research is still needed for drugs that lead to the same results as mitomycin, but with fewer side effects. More recent studies have focused on technologies that increase communication between target tissues and antifibrotic molecules at the cellular level, being a promising bet for the future.
C. M. de Oliveira (&) J. L. M. Ferreira Faculdade de Medicina, Unichristus, Fortaleza, Ceara´, Brazil e-mail: [email protected]
Keywords Filtering surgery Glaucoma Wound healing Fibrosis Neovascularization Drug discovery
Introduction Trabeculectomy (TREC) is the most commonly used fistulizing surgery to treat glaucoma. The meticulous postoperative period is fundamental to its success and can be more challenging than the procedure itself since it is associated with many complications. Excessive subconjunctival scarring is the primary cause of surgical failure and is related to the malfunction of the filtering bleb. The use of currently available antiproliferative agents, 5-fluorouracil (5-FU) and mitomycin C (MMC), aimed at controlling postoperative healing, is limited by the risk of complications that can lead to blindness, such as leakage of the filtering bleb, hypotonia and infectious endophthalmitis. Given this, the number of studies aimed at the discovery of new drugs for adjuvant treatment in glaucoma fistulizing surgeries has been growing in recent years, opening up the prospect for the research of new healing modulating agents [1–10]. The purpose of this article was to bring updates about the options for healing modulating drugs researched as adjuncts to TREC.
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Int Ophthalmol
Methods
Discussion
This is a retrospective study, by a systematic review without meta-analysis. The authors used the PubMed and SciELO database and the search terms ‘‘filtering surgery’’ and ‘‘glaucoma’’ with publications dating from 1972 to 2019. For further identifying potentially topic-related revi
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