Excessive scarring in glaucoma surgery. Part 2: Anti-inflammatory therapy, antimetabolites, angiogenesis inhibitors

The main complication of glaucoma surgery is excessive scarring of newly created aqueous humor outflow pathways. To prevent fibrotic tissue formation, medications with different mechanisms of action are used intraoperatively and during the early postoperative period.The primary group of anti-inflammatory drugs used in glaucoma surgery are topical steroids. A particularly high antiinflammatory efficacy has been demonstrated with a slowrelease dexamethasone implant placed under the scleral flap.Nonsteroidal anti-inflammatory drugs, in addition to their direct effect, can potentiate the hypotensive action of prostaglandin analogs and reduce the severity of their local side effects. The use of antimetabolites such as mitomycin C and 5-fluorouracil is justified by their antifibrotic activity, which inhibits DNA synthesis and, consequently, the proliferation of cells including myofibroblasts. However, they are associated with a high risk of hypotonic complications. Angiogenesis inhibitors suppress vascular endothelial growth factor production and thus block proliferation.The use of ranibizumab, bevacizumab, and infliximab as adjuncts to standard therapy can enhance the longterm effectiveness of glaucoma surgery. However, their use remains limited and not fully explored.