str. 46 - 49
Modyfikacja procesu gojenia pęcherzyka filtracyjnego w chirurgii jaskry
Modification of Wound Healing after Glaucoma Surgery
Joanna Piłat, Ewa Kosior-Jarecka, Dominika Wróbel-Dudzińska, Tomasz Żarnowski
Klinika Diagnostyki i Mikrochirurgii Jaskry Uniwersytetu Medycznego w Lublinie
Samodzielny Publiczny Szpital Kliniczny nr 1 w Lublinie
Kierownik: prof. dr hab. n. med. Tomasz Żarnowski
Summary: Glaucoma is a progressive neuropathy of the optic nerve. Lowering of intraocular pressure is currently the only method of slowing down the progression of the disease. Treatment includes the administration of local hypotensive drugs, laser and surgical procedures. Trabeculectomy is the golden standard in glaucoma surgery by creating a fistula from natural tissues. Post-operative secretion of proinflammatory cytokines, growth factors, fibroblast proliferation and angiogenesis accelerate scarring and fibroris which lead to filtration failure. The delay in healing prolongs proper filtration. Modulation of this process includes pharmacological preparation of tissues prior to surgery, performing a filtration procedure in combination with medicaments and a long-term post-operative treatment to prevent scarring of the wound. Proper qualification of the patient at risk of failure to the surgery gives the possibility to implement appropriate strategies. The antiproliferative agents currently used (5-fluorouracil, mitomycin C) have serious side effects: leakage from the bleb and endophthalmitis. Good results are obtained by the use of agents against vascular endothelial growth factor (bevacizumab) and transforming growth factor, however, more data on the effects of their action are needed. In the experimental phase, there are many pharmacological, physical and biological strategies for modulation of wound healing. The aim of this review is to present pathogenesis of wound healing, standard methods of modification and possible new therapeutic strategies for long-term filtration success.
Słowa kluczowe: gojenie, pęcherzyk, chirurgia jaskry, trabekulektomia, niepowodzenie filtracji.
Keywords: wound healing, bleb, glaucoma surgery, trabeculectomy, filtration failure.