Improving patient outcomes following glaucoma surgery: state of the art and future perspectives

Abstract

Of all the treatments currently used to lower intraocular pressure in glaucoma patients, filtration surgery is known to be the most effective. However, in a significant percentage of cases, the constructed channel closes due to excessive scar formation, resulting in surgical failure. The process of postoperative wound healing is characterized by the coagulative and inflammatory phase, followed by the proliferative and repair phase, and finally the remodeling phase. Perioperative antimitotic agents, such as mitomycin C and 5-fluorouracil, are known to modulate the process of wound healing and to improve surgical outcome, but they carry a risk of vision-threatening complications. New alternative strategies to prevent filtration failure, such as inhibition of transforming growth factor-β, vascular endothelial growth factor, and placental growth factor, have shown promising results in the improvement of surgical success. However, it remains necessary to broaden the therapeutic approach by focusing on combined therapies and on extended drug delivery.

Anticancer Antibiotics

“…The specific therapeutic use of daunorubicin is for treatment of acute leukemia (Kingston and Newman 2008;Trevor et al 2008). Epirubicin (3), a semisynthetic derivative of doxorubicin with less cardiotoxic activity, is used in gastric and breast cancer.…”

“…Epirubicin (3), a semisynthetic derivative of doxorubicin with less cardiotoxic activity, is used in gastric and breast cancer. Idarubicin (4), an analogue of daunorubicin with higher efficacy, has been applied in acute myelogenous leukemia, while valrubicin (5) is beneficent in treatment of early bladder cancer (Cortés-Funes and Coronado 2007;Trevor et al 2008). Pirarubicin (6) is another doxorubicin derivative, which is indicated in breast cancer.…”

“…Bleomycin is a part of the drug mixture applied in lymphomas, testicular cancer and squamous cell carcinoma; it is also used to treat brain tumors (Trevor et al 2008;Linnert and Gehl 2009). Although phleomycins (e.g.…”

Efeito do ácido rosmarínico sobre parâmetros cicatriciais relacionados à cirurgia antiglaucomatosa experimental

“…Estudo in vitro demonstrou que cinco minutos de exposição ao 5-FU pode ter um efeito inibitório de até 30 dias na cultura de fibroblastos da Tenon (KHAW et al, 1992). Os efeitos adversos do 5-FU são reflexos de sua interferência nas células com maior replicação, causando defeitos epiteliais corneanos e vazamento conjuntival, com maior risco de complicações decorrentes de ampolas isquêmicas, como endoftalmite e maculopatia hipotônica (SHAPIRO et al, 1985;VAN BERGEN et al, 2014). …”

“…Além disso, os pacientes submetidos à TREC têm níveis elevados de VEGF no humor aquoso e vários estudos testaram anticorpos anti-VEGF como opção terapêutica para o atual tratamento adjuvante antiproliferativo (GREWAL et al, 2008;LI et al, 2009;MATHEW;BARTON, 2011;O'NEILL et al, 2010;PAULA et al, 2013;VAN BERGEN et al, 2011 (LI et al, 2009;LUKOWSKI et al, 2013;MATHEW;BARTON, 2011;MEMARZADEH et al, 2009;PAULA et al, 2013;TURGUT et al, 2014TURGUT et al, , 2015.…”