Biological basis and clinical potential of wound healing modulators in glaucoma surgery

The purpose of this review is to analyze the molecular mechanisms of postoperative fibrosis of the filtering bleb and critically evaluate pharmacological approaches to modulating its key mediators as a basis for developing more effective and safer strategies to prolong the hypotensive effect of trabeculectomy. This review examines current approaches to the management of reparative processes in open-angle glaucoma surgery aimed at preventing excessive fibrosis of the outflow pathways and prolonging the hypotensive effect. Glaucoma continues to be the leading cause of irreversible blindness, and surgical reduction of intraocular pressure is the most effective treatment when medical therapy is insufficient. However, up to 50% of surgical procedures fail within 5 years because of subconjunctival and episcleral fibrosis. The review considers the key phases and molecular markers of wound healing (inflammation, proliferation, and remodeling) and the role of fibroblasts as effector cells. The article also analyzes the methods used in clinical practice to modulate wound healing, including steroids, mitomycin C, 5-fluorouracil, immunosuppressants, and angiogenesis inhibitors, from the standpoint of the benefit-risk ratio, and discusses various methods of drug delivery. Despite considerable progress, existing approaches do not fully meet the criteria of safety and effectiveness, highlighting the need for further experimental and clinical studies.