Filtering surgeries are frequently used for controlling intraocular pressure in
glaucoma patients. The long-term success of operation is intimately influenced by the process of wound healing at the site of surgery. Indeed, if has not been anticipated and managed accordingly,
filtering surgery in high-risk patients could end up in
bleb failure. Several strategies have been developed so far to overcome excessive
scarring after
filtering surgery. The principal step involves meticulous tissue handling and modification of surgical technique, which can minimize the severity of wound healing response at the first place. However, this is usually insufficient, especially in those with high-risk criteria. Thus, several adjuvants have been tried to stifle the exuberant
scarring after
filtration surgery. Conventionally,
corticosteroids and
anti-fibrotic agents (including
5-fluorouracil and
Mitomycin-C) have been used for over three decades with semi-acceptable outcomes.
Blebs and
bleb associated complications are catastrophic side effects of
anti-fibrotic agents, which occasionally are encountered in a subset of patients. Therefore, research continues to find a safer, yet effective adjuvant for
filtering surgery. Recent efforts have primarily focused on selective inhibition of
growth factors that promote
scarring during wound healing process. Currently, only anti-
VEGF agents have gained widespread acceptance to be translated into routine clinical practice. Robust evidence for other agents is still lacking and future confirmative studies are warranted. In this review, we explain the importance of wound healing process during
filtering surgery, and describe the conventional as well as potential future adjuvants for filtration surgeries.