Collotta Debora, Colletta Simona, Carlucci Virginia, Fruttero Claudia, Fea Antonio Maria, Collino Massimo
Department of Neurosciences "Rita Levi Montalcini", University of Turin, 10126 Turin, Italy.
Chemsafe S.r.l., Via Ribes 5, 10010 Colleretto Giacosa, Italy.
Pharmaceuticals (Basel). 2023 Jun 19;16(6):898. doi: 10.3390/ph16060898.
Glaucoma is an acquired optic neuropathy that results in a characteristic optic nerve head appearance and visual field loss. Reducing the IOP is the only factor that can be modified, and the progression of the disease can be managed through medication, laser treatment, or surgery. Filtering procedures are used when target pressure cannot be obtained with less invasive methods. Nevertheless, these procedures require accurate control of the fibrotic process, which can hamper filtration, thus, negatively affecting the surgical success. This review explores the available and potential pharmacological treatments that modulate the scarring process after glaucoma surgery, analyzing the most critical evidence available in the literature. The modulation of scarring is based on non-steroidal anti-inflammatory drugs (NSAIDs), mitomycin, and 5-fluorouracil. In the long term, the failure rate of filtering surgery is mainly due to the limitations of the current strategies caused by the complexity of the fibrotic process and the pharmacological and toxicological aspects of the drugs that are currently in use. Considering these limitations, new potential treatments were investigated. This review suggests that a better approach to tackle the fibrotic process may be to hit multiple targets, thus increasing the inhibitory potential against excessive scarring following surgery.
青光眼是一种获得性视神经病变，会导致特征性的视神经乳头外观和视野缺损。降低眼压是唯一可以改变的因素，并且可以通过药物、激光治疗或手术来控制疾病的进展。当采用侵入性较小的方法无法达到目标眼压时，会使用滤过手术。然而，这些手术需要精确控制纤维化过程，因为纤维化会阻碍滤过，从而对手术成功率产生负面影响。这篇综述探讨了可用于调节青光眼手术后瘢痕形成过程的现有和潜在药物治疗方法，并分析了文献中最关键的证据。瘢痕形成的调节基于非甾体抗炎药（NSAIDs）、丝裂霉素和5-氟尿嘧啶。从长期来看，滤过手术的失败率主要是由于当前策略存在局限性，这些局限性是由纤维化过程的复杂性以及目前使用药物的药理和毒理学方面的问题所导致的。考虑到这些局限性，人们对新的潜在治疗方法进行了研究。这篇综述表明，应对纤维化过程的更好方法可能是针对多个靶点，从而增强对手术后过度瘢痕形成的抑制潜力。
