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Viewpoint | Translational Science With Clinical Promise

Combination Therapy to Reduce Conjunctival Scarring After Glaucoma Surgery

Marco A. Zarbin, MD, PhD1
[+] Author Affiliations
1New Jersey Medical School, Institute of Ophthalmology and Visual Science, Newark
JAMA Ophthalmol. 2013;131(9):1123. doi:10.1001/jamaophthalmol.2013.5575.
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Glaucoma is the second leading cause of blindness worldwide.1 Although the mainstay of glaucoma therapy is medical management,2 surgery is an important yet complex component of treatment for many patients. While filtration surgery often achieves intraocular pressures lower than those achieved with medicine or laser surgery, excessive bleb scarring is a common cause of surgical failure. The scarring involves fibroblasts of the fascia bulbi (also known as the Tenon capsule, after the French surgeon and pathologist Jacques-Renee Tenon). Managing the wound-healing response requires achieving a precarious balance between inhibiting scarring and permitting scarring. With too little scarring, there is a higher likelihood of overfiltration, hypotony, and choroidal detachment. Mitomycin C (MMC) promotes prolonged filtration by inducing apoptosis of human Tenon fibroblasts. However, MMC can be associated with complications such as hypotony maculopathy3 and bleb leaks.4 Thus, additional improvements in the control of wound healing would probably make incisional glaucoma surgery safer and more effective.5

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