Abstract
Trabeculectomy fails to control the intra-ocular pressure adequately in a proportion of patients. Approaches to solving this problem have involved modifications of surgery, histological studies of tissue from failed and functioning blebs, animal studies, and in vitro investigations of some of the basic processes of wound healing. This paper reviews the current state of investigations in these disciplines with particular reference to wound healing in this specialised site.
Similar content being viewed by others
Article PDF
References
Gressel MG, Heuer DK, Parrish RK . Trabecu-ectomy in young patients. Ophthalmology 1984; 91: 1242–6.
Singleton BJ, Distler JA, Baker BH . Filtration surery in black patients — early results in a West Indian population. Ophthal Surg 1987; 18: 195–9.
Miller MH, Joseph NH, Wishart RK, Hitchings RA . Lack of beneficial effect of intensive topical steroids and beta irradiation of eyes undergoing repeat trabeculectomy. Ophthal Surg 1987; 18: 508–12.
Migdal C, Hitchings RA . Effect of antipros-taglandins on glaucoma filtering surgery. Trans Ophthalmol Soc UK 1982; 102: 129–32.
Agbeja AM, Dutton GN . Conjunctival incisions for trabeculectomy and their relationship to the type of bleb formation — a preliminary study. Eye 1987; 1: 738–43.
Sherwood MB, Spaeth GL, Simmons ST, et al.. Cysts of Tenon's capsule following filtration surgery — medical management. Arch Ophthalmol 1987; 105: 1517–21.
Addicks EA, Quigley HA, Green WR, et al.. Histological characteristics of filtering blebs in glaucomatous eyes. Arch Ophthalmol 1983; 101: 795–8.
Hitchings RA, Grierson I . Clinico-pathological correlation in eyes with failed fistulising surgery. Trans Ophthalmol Soc VK 1983; 103: 84–8.
Ellet EC . A study of trephine wounds of the sclera and corneoscleral junction. Trans Sec Ophthalmol Am Med Ass 1914: 390–4.
Clausen O . Erfahrungen mit Elliotscher trepanation. Ztschr f Augenh 1917; 29: 197.
Gherezghiher T, March WF, Koss MC, et al.. Neodymium-YAG laser sclerostomy in primates. Arch Ophthalmol 1985; 103: 1543–5.
Holth S . Anatomical examination of new six cases from five months to six years after successful iridencleisis or limbal sclerectomy. Br J Ophthalmol 1922; 6: 10–22.
Spaeth GL . Glaucoma surgery. In Spaeth GL ed. Principles and practice of ophthalmic surgery. Philadelphia: WB Saunders 1982.
Miller MH, Joseph NH, Ennis KW, et al.. An animal model of filtration surgery. Trans Ophthalmol Soc UK 1985; 104: 893–7.
Seetner A, Morin JD . Healing of trabeculectomies in rabbits. Canad J Ophthalmol 1979; 14: 121–5.
Jampel HD, McGuigan LJB, Dunkelberger GR, et al.. Cellular proliferation after experimental glaucoma filtration surgery. Arch Ophthalmol 1988; 106: 89–94.
Desjardins DC, Parrish FK, Folberg R, et al.. Wound healing after filtering surgery in owl monkeys. Arch Ophthalmol 1986; 104: 1835–9.
Tripathi RC . Comparative physiology and anatomy of the aqueous outflow pathway. In Dawson H, Graham LT, eds. The Eye. London: Academic Press 1974.
McGuigan LJB, Cook DJ, Yablonski ME . Dexamethasone, D-penicillamine, and glaucoma filtering surgery in rabbits. Invest Ophthalmol Vis Sci 1986; 27: 1755–7.
McGuigan LJB, Mason RP, Sanchez R, et al.. D-penicillamine and beta-aminoproprionitrile effects on experimental filtering surgery. Invest Ophthalmol Vis Sci 1987; 28: 1625–9.
Miller MH . An animal model of fistulising surgery for glaucoma. MD Thesis. University of London 1988.
Reddick R, Merritt JC, Ross G, et al.. Myofibro-blasts in filtration operations. Ann Ophthalmol 1985; 17: 200–3.
Peacock EE . Wound repair. Philadelphia; WB Saunders 1984.
Unger WG, Cole DF, Hammond B . Disruption of the blood-aqueous barrier following paracentesis in the rabbit. Exp Eye Res 1975; 20: 255–70.
Gabbiani G, Hirschel BJ, Ryan GB, et al.. Granulation tissue as a contractile organ. A study of structure and function. J Exp Med 1972; 135: 719–34.
Grillo HC, Potsaid MS . Studies in wound healing: IV. Retardation of contraction by local x-irradiation, and observations relating to the origin of fibroblasts in repair. Ann Surg 1961; 154: 741–50.
Anton M, Riebel O . Influence of beta rays on the healing of corneo-scleral wounds. Scr Med Fac Med Brunensis 1961; 34: 293–6.
Laval J . Coles RS. Role of cortisone in glaucoma surgery. Experimental results. Arch Ophthalmol 1953; 49: 168–81.
Giangiacomo J, Dueker DK, Adelstein E . The effects of preoperative subconjunctival triam-cinolone administration on glaucoma filtration. I. Trabeculectomy. Arch Ophthalmol 1986; 104: 838–41.
Ball SF . Effects of triamcinolone injection (Letter). Arch Ophthalmol 1986; 104: 1749–50.
Gressel MG, Parrish RK, Folberg R . 5-Fluorouracil and glaucoma filtering surgery. An animal model. Ophthalmology 1984; 91: 378–83.
Skuta GL, Assil K, Parrish RK, et al.. Filtering surgery in owl monkeys treated with the anti-metabolite 5-fluorouridine 5″-monophosphate entrapped in multivesicular liposomes (Letter). Am J Ophthalmol 1987; 103: 714–6.
Kay JS, Litin BS, Jones MA, et al.. Delivery of the antifibroblast agents as adjuncts to filtration surgery. Part II. Delivery of 5-fluorouracil and bleomycin in a collagen implant; study in the rabbit. Ophthal Surg 1986; 17: 796–801.
Lee DA, Flores RA, Anderson PJ, et al.. Filtration surgery in rabbits using bioerodable polymers and 5-fluorouracil. Ophthalmology 1987; 94: 1523–30.
Larsson S . Les vaisseaux intra-oculaires du segment anterieur et leur influence sur la pression oculaire. Am Oculist Paris 1932; 169: 94–119.
Silver IA . Local and systemic factors which affect the proliferation of fibroblasts. In Kilonen E, Pikkarainen J eds. Biology of the fibroblast. London; Academic Press 1973: 507–19.
Freundlich B, Bomalaski JS, Neilson E, Jiminez SA . Regulation of fibroblast proliferation and collagen synthesis by cytokines. Immunol Today 1986; 7: 303–7.
Dawson W, Willoughby DA . Inflammation — mechanisms and mediators. In Lombardino JG ed. Non-steroidal anti-inflammatory drugs. London: John Wiley and Sons 1985: 76–109.
Ehrlich HP, Tarver H, Hunt TK . Effects of vitamin A and glucocorticoids upon inflammation and collagen synthesis. Ann Surg 1973; 177: 222–7.
Starita RJ, Fellman RL, Spaeth GL, et al.. Short-and long-term effects of postoperative corticosteroids on trabeculectomy. Ophthalmology 1985; 92; 938–46.
Molteno ACB, Straughan JL, Ancker E . Control of bleb fibrosis after glaucoma surgery by anti-inflammatory agents. S Afr Med J 1976; 50: 881–5.
Brown RD, Cairns JE . Experience with the Molteno long tube implant. Trans Ophthalmol Soc UK 1983; 103: 297–312.
Teng CC, Chi HH, and Katzin HM . Aqueous degenerative effects and the protective role of endothelium in eye pathology. Am J Ophthalmol 1960; 50: 365–79.
Kornblueth W, Tenenbaum E . The inhibitory effect of aqueous humour on the growth of cells in tissue culture. Am J Ophthalmol 1956; 42: 70–4.
Epstein E . Fibrosing response to aqueous. Its relation to glaucoma. Br J Ophthalmol 1959; 43: 641–7.
Herschier J . The inhibitory factor in aqueous humour. Vision Res 1981; 21: 163.
Herschler J, Claflin AJ, Fiorentino G . The effect of aqueous humour on the growth of subcon-junctival fibroblasts in tissue culture and its implications for glaucoma surgery. Am J Ophthalmol 1980; 89: 245–9.
Joseph JP, Grierson I, Hitchings RA . Normal rabbit aqueous humour, fibronectin, and fibroblast conditioned medium are chemoattractant to Tenon's capsule fibroblasts. Eye 1987; 1: 585–92.
Joseph JP, Grierson I, Hitchings RA . Chemotactic activity of aqueous humour: a cause of failure of trabeculectomies? Arch Ophthalmol (in press).
Reid T, Kenney MC, Waring G . Isolation and characterization of fibronectin from bovine aqueous humour. Invest Ophthalmol Vis Sci 1982; 22: 57–61.
Campochiaro PA, Jerdan JA, Glaser BM, et al.. Vitreous aspirates from patients with proliferative vitreoretinopathy stimulate retinal pigment epithelial cell migration. Arch Ophthalmol 1985; 103: 1403–5.
Chvapil M, Peacock EE, Carlson EC, et al.. Colchicine and wound healing. J Surg Res 1980; 28: 49–56.
Ehrlich HP, Grislis G, Hunt TK . Evidence for the involvement of microtubules in wound contraction. Am J Surg 1977; 133: 706–9.
Joseph JP, Grierson I, Hitchings RA . Taxol, cytochalasin B and colchicine effects on fibroblast migration and contraction: a role in glaucoma filtration surgery? (Submitted).
Lemor M, Yeo JH, and Glaser BM . Oral colchicine for the treatment of experimental traction retinal detachment. Arch Ophthalmol 1986; 104: 1226–9.
van Bockxmeer FM, Martin CE, Thompson DE, et al.. Taxol for the treatment of proliferative vitreoretinopathy. Invest Ophthalmol Vis Sci 1985; 26: 1140–7.
Madden JW, Morton D, Peacock EE . Contraction of experimental wounds. 1 Inhibiting wound contraction by using a topical smooth muscle antagonist. Surgery 1974; 76: 8–15.
Harris AK . Cell surface movements related to cell locomotion. In Locomotion of tissue cells. Ciba foundation symposium 14. Amsterdam: Elsevier 1973: 3–26.
Glaser BM, Cardin A, Biscoe B . Proliferative vitreoretinopathy. The mechanism of development of vitreoretinal traction. Ophthalmology 1987; 94: 327–32.
Forrester JV, Docherty R, Kerr C, et al.. Cellular proliferation in the vitreous: the use of vitreous explants as a model system. Invest Ophthalmol Vis Sci 1986; 27: 1085–94.
Verdoon C, Renardel de Lavalette VW, Dalma-Weizhausz J, et al.. Cellular migration, proliferation, and contraction, an in vitro approach to a clinical problem — proliferative vitreoretinopathy. Arch. Ophthalmol 1986; 104: 1216–19.
Ehrlich HP, Rajaratnam JBM, and Griswold TR . ATP-induced cell contraction in dermal fibroblasts: effects of cAMP and myosin light-chain kinase. J Cell Phys 1986; 128: 223–30.
Masuda H, Owaribe K, Hatano S . Contraction of Triton-treated culture cells. A calcium-sensitive contractile model. Exp Cell Res 1983; 143: 79–90.
Joseph J, Grierson I, Hitchings RA . Exogenous ATP causes the contraction of intact fibroblasts in vitro. Exp Cell Res 1988; 176: 1–12.
Arem AJ, Misiorowski R, Chvapil M . Effects of low dose BAPN on wound healing. J Surg Res 1979; 27: 228–32.
Peacock EE . Pharmacologic control of surface scarring in human beings. Ann Surg 1981; 193: 592–7.
Baum BJ, Moss J, Breul SD, et al.. Association in normal human fibroblasts of elevated levels of adenosine 3;″ 5″-monophosphate with a selective decrease in collagen production. J Biol Chem 1978; 253: 3391–4.
Uitto J, Tan EML, and Ryhanen L . Inhibition of collagen accumulation in fibrotic processes. Review of pharmacologic agents and new approaches with amino acids and their analogues. J Invest Dermatol 1982; 79: 113s–120s.
Author information
Authors and Affiliations
Additional information
We gratefully acknowledge the Trustees of the T F C Frost Charitable Trust who supported the studies of Dr Joseph and Mr Miller at the Institute of Ophthalmology.
Rights and permissions
About this article
Cite this article
Joseph, J., Miller, M. & Hitchings, R. Wound healing as a barrier to successful filtration surgery. Eye 2 (Suppl 1), S113–S123 (1988). https://doi.org/10.1038/eye.1988.138
Issue Date:
DOI: https://doi.org/10.1038/eye.1988.138
This article is cited by
-
Effect of connective tissue growth factor gene editing using adeno-associated virus–mediated CRISPR–Cas9 on rabbit glaucoma filtering surgery outcomes
Gene Therapy (2021)
-
Comparison of 1-year outcomes after Ahmed glaucoma valve implantation with and without Ologen adjuvant
BMC Ophthalmology (2018)
-
Application of hyaluronidase after unsuccessful trabeculectomy
Documenta Ophthalmologica (1992)
-
The management of post-keratoplasty glaucoma by trabeculectomy
Eye (1989)