Wound healing in glaucoma surgery. Part 2. Risk factors
https://doi.org/10.21516/2072-0076-2025-18-1-145-149
Abstract
Surgical treatment of glaucoma is a common method of intraocular pressure normalizing when other treatment methods are not effective enough. However, hypotensive intervention does not guarantee a stable hypotensive effect, which is due to the processes of excessive scarring with difficulty in the outflow of intraocular fluid in the area of antiglaucoma surgery. When choosing the tactics of surgical treatment and methods of postoperative management, risk factors for the development of excessive scarring should be taken into account. Among them are the young age of patients, race, high initial intraocular pressure, long-term use of local hypotensive therapy, the presence of inflammatory pathology, previous hypotensive intervention and / or intraocular surgery, neovascular glaucoma, diabetes mellitus.
About the Authors
N. S. Izmailova
Helmholtz National Medical Research Center of Eye Diseases
Russian Federation
Russian Federation
Natalia S. Izmailova — head of the department of pathological anatomy and histology, leading researcher, pathologist.
14/19, Sadovaya-Chernogryazskaya St., Moscow, 105062
S. Yu. Petrov
Helmholtz National Medical Research Center of Eye Diseases
Russian Federation
Russian Federation
Sergey Yu. Petrov — Dr. of Med. Sci., head of glaucoma department.
14/19, Sadovaya-Chernogryazskaya St., Moscow, 105062
A. D. Epkhieva
Helmholtz National Medical Research Center of Eye Diseases
Russian Federation
Russian Federation
Angela D. Epkhieva — PhD student, glaucoma department.
14/19, Sadovaya-Chernogryazskaya St., Moscow, 105062
References
1. Tham YC, Li X, Wong TY, et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014; 121 (11): 2081–2090. doi:10.1016/j.ophtha.2014.05.013
2. Neroev V.V., Kiseleva O.A., Bessmertny A.M. The main results of a multicenter study of epidemiological features of primary open-angle glaucoma in the Russian Federation. Russian ophthalmological journal. 2013; 6 (3): 4–7 (In Russ.).
3. Quigley H.A., Broman A.T. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006; 90 (3): 262–7. doi:10.1136/bjo.2005.081224
4. Sotimehin A.E., Ramulu P.Y. Measuring Disability in Glaucoma. J Glaucoma. 2018; 27 (11): 939–49. doi:10.1097/IJG.0000000000001068
5. Clinical Gidelines “Primary open angle glaucoma”. 2020 (16.02.2021), Approved by the Ministry of Health of the Russian Federation (In Russ.).
6. Saheb H, Ahmed II. Micro-invasive glaucoma surgery: current perspectives and future directions. Curr Opin Ophthalmol. 2012; 23 (2): 96–104. doi:10.1097/ICU.0b013e32834ff1e7
7. Kamenskikh T.G., Veselova E.V., Kolbenev I.O., Petrova Y.V. Effect of different preservatives on the cornea during instillation of prostaglandin analogues. Russian journal of Glaucoma. 2015; 14 (3): 49–57 (In Russ.).
8. Petrov S.Yu., Vostrukhin S.V., Aslamazova A.E., Sherstneva L.V. Modern methods of minimally invasive glaucoma surgery. Vestnik oftal’mologii. 2016; 132 (3): 96–102 (In Russ.). doi:10.17116/oftalma2016132396-102
9. Petrov S.Yu., Safonova D.M. The modern concept of wound healing in glaucoma surgery. Ophthalmology in Russia. 2015; 12 (4): 9–17 (In Russ.). doi:10.18008/1816-5095-2015-4-9-17
10. Slonimskiy A.Yu., Alekseyev I.B., Dolgiy S.S. New possibilities of excessive postoperative scarring prophylaxis by glaucoma surgery. Ophthalmology in Russia. 2012; 9 (3): 36–40 (In Russ.).
11. Izmailova N.S., Petrov S.Yu., Dzebisova A.D. Wound healing in glaucoma surgery. Part 1. Wound healing morphology. Russian ophthalmological journal. 2024; 17 (4): 116–20 (In Russ.). https://doi.org/10.21516/2072-0076-2024-17-4-116-120
12. Bessmertny A.M., Erichev V.P. Algorithm of surgical treatment of refractory glaucoma. In the book: Glaucoma: problems and solutions. Moscow. 271–2 (In Russ.).
13. European Glaucoma Society. Terminology and guidelines for glaucoma. 5th edition ed: Savona, Italy PubliComm; 2020.
14. Khaw PT, Chiang M, Shah P, et al. Enhanced trabeculectomy: the moorfields safer surgery system. Dev Ophthalmol. 2017; 59: 15–35. doi: 10.1159/000458483
15. Investigators A. The Advanced Glaucoma Intervention Study (AGIS): 11 Risk factors for failure of trabeculectomy and argon laser trabeculoplasty. Am J Ophthalmol. 2002; 134 (4): 481–98. doi:10.1016/s0002-9394(02)01658-6
16. Sussman MD. Aging of connective tissue: physical properties of healing wounds in young and old rats. Am J Physiol. 1973; 224 (5): 1167–71. doi:10.1152/ajplegacy.1973.224.5.1167
17. Landers J, Martin K, Sarkies N, Bourne R, Watson P. A twenty-year follow-up study of trabeculectomy: risk factors and outcomes. Ophthalmology. 2012; 119 (4): 694–702. doi:10.1016/j.ophtha.2011.09.043
18. Fontana H, Nouri-Mahdavi K, Caprioli J. Trabeculectomy with mitomycin C in pseudophakic patients with open-angle glaucoma: outcomes and risk factors for failure. Am J Ophthalmol. 2006; 141 (4): 652–9. doi:10.1016/j.ajo.2005.11.039
19. Khaw PT, Chiang M, Shah P, et al. Enhanced trabeculectomy: the Moorfields Safer Surgery. System Dev Ophthalmol. 2012; 50: 1–28. doi:10.1159/000334776
20. Gressel MG, Heuer DK, Parrish RK, 2nd. Trabeculectomy in young patients. Ophthalmology. 1984; 91 (10): 1242–6. doi:10.1016/s0161-6420(84)34179-3
21. Merritt JC. Filtering procedures in American blacks. Ophthalmic Surg. 1980; 11 (2): 91–4.
22. Miller RD, Barber JC. Trabeculectomy in black patients. Ophthalmic Surg. 1981; 12 (1): 46–50. PMID: 7231869.
23. Shingleton BJ, Distler JA, Baker BH. Filtration surgery in black patients: early results in a West Indian population. Ophthalmic Surg. 1987 Mar; 18 (3): 195–9. PMID: 3587859.
24. Broadway D, Grierson I, Hitchings R. Racial differences in the results of glaucoma filtration surgery: are racial differences in the conjunctival cell profile important? Br J Ophthalmol. 1994; 78 (6): 466–75. doi:10.1136/bjo.78.6.466
25. Montagna W, Carlisle K. The architecture of black and white facial skin. J Am Acad Dermatol. 1991; 24 (6 Pt 1): 929–37. doi:10.1016/0190-9622(91)70148-u
26. Berardesca E, de Rigal J, Leveque JL, Maibach HI. In vivo biophysical characterization of skin physiological differences in races. Dermatologica. 1991; 182 (2): 89–93. doi:10.1159/000247752
27. McNair SS. Chronic simple glaucoma in the Negro. Am J Ophthalmol. 1951; 34 (1): 70–6. doi:10.1016/0002-9394(51)91929-0
28. Scott JG. The eye of the West African Negro. Br J Ophthalmol. 1945; 29 (1): 12–9. doi:10.1136/bjo.29.1.12
29. Musch DC, Gillespie BW, Niziol LM, Cashwell LF, Lichter PR, Collaborative Initial Glaucoma Treatment Study G. Factors associated with intraocular pressure before and during 9 years of treatment in the Collaborative Initial Glaucoma Treatment Study. Ophthalmology. 2008; 115 (6): 927–33. doi:10.1016/j.ophtha.2007.08.010
30. Hallaj S, Wong JC, Hock LE, et al. Long-term surgical outcomes of glaucoma drainage implants in eyes with preoperative intraocular pressure less than 19 mmHg. J Ophthalmol. 2024; 2024: 6624021. doi:10.1155/2024/6624021
31. Yu DY, Morgan WH. Sun X, et al. The critical role of the conjunctiva in glaucoma filtration surgery. Prog Retin Eye Res. 2009; 28 (5): 303–28. doi:10.1016/j.preteyeres.2009.06.004
32. Baudouin C, Hamard P, Liang H, et al. Conjunctival epithelial cell expression of interleukins and inflammatory markers in glaucoma patients treated over the long term. Ophthalmology. 2004; 111(12): 2186–92. doi:10.1016/j.ophtha.2004.06.023
33. Baudouin C, Labbe A, Liang H, Pauly A, Brignole-Baudouin F. Preservatives in eyedrops: the good, the bad and the ugly. Prog Retin Eye Res. 2010; 29 (4): 312–34. doi:10.1016/j.preteyeres.2010.03.001
34. Baudouin C, Liang H, Hamard P, et al. The ocular surface of glaucoma patients treated over the long term expresses inflammatory markers related to both T-helper 1 and T-helper 2 pathways. Ophthalmology. 2008; 115 (1): 109–15. doi:10.1016/j.ophtha.2007.01.036
35. Baudouin C, Pisella PJ, Fillacier K, et al. Ocular surface inflammatory changes induced by topical antiglaucoma drugs: human and animal studies. Ophthalmology. 1999; 106 (3): 556–63. doi:10.1016/S0161-6420(99)90116-1
36. Broadway DC, Grierson I, Hitchings RA. Local effects of previous conjunctival incisional surgery and the subsequent outcome of filtration surgery. Am J Ophthalmol. 1998; 125 (6): 805–18. doi:10.1016/s0002-9394(98)00045-2
37. Broadway DC, Grierson I, O’Brien C, Hitchings RA. Adverse effects of topical antiglaucoma medication. II. The outcome of filtration surgery. Arch Ophthalmol. 1994; 112 (11): 1446–54. doi:10.1001/archopht.1994.01090230060021
38. Mastropasqua L, Agnifili L, Mastropasqua R, Fasanella V. Conjunctival modifications induced by medical and surgical therapies in patients with glaucoma. Curr Opin Pharmacol. 2013; 13 (1): 56–64. doi:10.1016/j.coph.2012.10.002
39. Villani E, Sacchi M, Magnani F, et al. The ocular surface in medically controlled glaucoma: An in vivo confocal study. Invest Ophthalmol Vis Sci. 2016; 5 7(3): 1003–10. doi:10.1167/iovs.15-17455
40. Ammar DA, Noecker RJ, Kahook MY. Effects of benzalkonium chloride-preserved, polyquad-preserved, and sofZia-preserved topical glaucoma medications on human ocular epithelial cells. Adv Ther. 2010; 27 (11): 837–45. doi:10.1007/s12325-010-0070-1
41. Epstein SP, Chen D, Asbell PA. Evaluation of biomarkers of inflammation in response to benzalkonium chloride on corneal and conjunctival epithelial cells. J Ocul Pharmacol Ther. 2009; 25 (5): 415–24. doi:10.1089/jop.2008.0140
42. Noecker R. Effects of common ophthalmic preservatives on ocular health. Adv Ther. 2001; 18 (5): 205–15. doi:10.1007/BF02853166
43. Pilat J, Przekora A, Wrobel-Dudzinska D, et al. Analysis of the impact of different schemes of preparation to trabeculectomy on the healing markers on the Tenon fibroblasts cultures. Sci Rep. 2023; 13 (1): 16353. doi:10.1038/s41598-023-43246-z
44. Inaba Z. Long-term results of trabeculectomy in the Japanese: an analysis by life-table method. Jpn J Ophthalmol. 1982; 26 (4): 361–73. PMID: 7166896
45. Broadway DC, Chang LP. Trabeculectomy, risk factors for failure and the preoperative state of the conjunctiva. J Glaucoma. 2001; 10 (3): 237–49. doi:10.1097/00061198-200106000-00017
46. Watson PG, Grierson I. The place of trabeculectomy in the treatment of glaucoma. Ophthalmology. 1981; 88 (3): 175–96. doi:10.1016/s0161-6420(81)35051-9
47. Schultz G, Khaw PT, Oxford K, et al. Growth factors and ocular wound healing. Eye (Lond). 1994; 8 (Pt 2): 184–187. doi:10.1038/eye.1994.43
48. Steed DL. The role of growth factors in wound healing. Surg Clin North Am. 1997; 77 (3): 575–86. doi:10.1016/s0039-6109(05)70569-7
49. Joseph JP, Grierson I, Hitchings RA. Chemotactic activity of aqueous humor. A cause of failure of trabeculectomies? Arch Ophthalmol. 1989; 107 (1): 69–74. doi:10.1001/archopht.1989.01070010071030
50. Inoue T, Kawaji T, Inatani M, et al. Simultaneous increases in multiple proinflammatory cytokines in the aqueous humor in pseudophakic glaucomatous eyes. J Cataract Refract Surg. 2012; 38 (8): 1389–97. doi:10.1016/j.jcrs.2012.04.028
51. Radius RL, Herschler J, Claflin A, Fiorentino G. Aqueous humor changes after experimental filtering surgery. Am J Ophthalmol. 1980; 89 (2): 250–4. doi:10.1016/0002-9394(80)90119-1
52. Herschler J. The effect of total vitrectomy on filtration surgery in the aphakic eye. Ophthalmology. 1981; 88 (3): 229–32. doi:10.1016/s0161-6420(81)35045-3
53. Herschler J. Medically uncontrolled glaucoma in the aphakic eye. Ann Ophthalmol. 1981 Aug; 13 (8): 909. PMID: 7294631.
54. Susanna R, Jr, Nicolela MT, Takahashi WY. Mitomycin C as adjunctive therapy with glaucoma implant surgery. Ophthalmic Surg. 1994 Jul; 25 (7): 458–62. PMID: 7970517.
55. Karalekas DHA, Rosenberg L, Ruderman J, Krupin T. Effects of human glaucomatous and non-glaucomatous aqueous humor on fibroblast proliferation in vitro. Invest Ophthalmol Vis Sci. 1994; 35 (4): 1898.
56. Chen KH, Wu CC, Roy S, Lee SM, Liu JH. Increased interleukin-6 in aqueous humor of neovascular glaucoma. Invest Ophthalmol Vis Sci. 1999 Oct; 40 (11): 2627–32. PMID: 10509659.
57. Costa L, Cunha JP, Amado D, Pinto LA, Ferreira J. Diabetes mellitus as a risk factor in glaucoma’s physiopathology and surgical survival time: A literature review. J Curr Glaucoma Pract. 2015; 9 (3): 81–5. doi:10.5005/jp-journals-10008-1190
58. Law SK, Hosseini H, Saidi E, et al. Long-term outcomes of primary trabeculectomy in diabetic patients with primary open angle glaucoma. Br J Ophthalmol. 2013; 97 (5): 561–6. doi:10.1136/bjophthalmol-2012-302227
59. Mermoud A, Salmon JF, Straker C. Murray AD. Post-traumatic angle recession glaucoma: a risk factor for bleb failure after trabeculectomy. Br J Ophthalmol. 1993; 77 (10): 631–4. doi:10.1136/bjo.77.10.631
60. Laganowski HC, Kerr Muir MG, Hitchings RA. Glaucoma and the iridocorneal endothelial syndrome. Arch Ophthalmol. 1992; 110 (3): 346–50. doi:10.1001/archopht.1992.01080150044025
61. Daicker B, Sturrock G, Guggenheim R. Clinicopathologic correlation in Cogan-Reese syndrome. Klin Monbl Augenheilkd. 1982; 180 (6): 531–8. doi:10.1055/s-2008-1055140
62. Wright MM, Grajewski AL, Cristol SM, Parrish RK. 5-Fluorouracil after trabeculectomy and the iridocorneal endothelial syndrome. Ophthalmology. 1991; 98 (3): 314–6. doi:10.1016/s0161-6420(91)32294-2
63. Broadway DC, Bates AK, Lightman SL, Grierson I, Hitchings RA. The importance of cellular changes in the conjunctiva of patients with uveitic glaucoma undergoing trabeculectomy. Eye (Lond). 1993; 7 (4): 495–501. doi:10.1038/eye.1993.108
64. Towler HM, Bates AK, Broadway DC, Lightman S. Primary trabeculectomy with 5-fluorouracil for glaucoma secondary to uveitis. Ocul Immunol Inflamm. 1995; 3 (3): 163–70. doi:10.3109/09273949509069109
65. Elder MJ. The role of cytokines in chronic progressive conjunctival cicatrisation. Dev Ophthalmol. 1997; 28: 159–75. doi:10.1159/000060714
Review
For citations:
Izmailova N.S., Petrov S.Yu., Epkhieva A.D. Wound healing in glaucoma surgery. Part 2. Risk factors. Russian Ophthalmological Journal. 2025;18(1):145-149. (In Russ.) https://doi.org/10.21516/2072-0076-2025-18-1-145-149
Views:
171
Email this article 