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Editors Selection IGR 9-3
Surgical Treatment: Biomarkers of Fibrosis
Comment by Esther Hoffmann on:
74514 Genotype-Phenotype Associations of IL6 and PRG4 With Conjunctival Fibrosis After Glaucoma Surgery, Yu-Wai-Man C; Tagalakis AD; Meng J et al., JAMA ophthalmology, 2017; 135: 1147-1155
Success of glaucoma filtration surgery depends on the amount of fibrosis developing at the surgical site. The prevention of scarring of the surgical opening allowing filtration from the anterior chamber into the subconjunctival space is the big challenge in filtering surgery.
The process of wound healing starts immediately after injury to the conjunctiva. During this phase of consecutive steps inflammatory cytokines such as interleukin 6 (IL6) play a major role in the formation of fibrosis. Furthermore, the glycoprotein proteoglycan 4 (PRG4) has been detected at the ocular surface and might be protective and stabilisators after an injury of the conjunctiva.
Yu-Wai-Man and co-authors performed a cross-sectional study and included 42 glaucoma patients. Of these, 28 had undergone glaucoma surgery and 14 patients had no previous glaucoma surgery. Patients with glaucoma surgery showed conjunctival fibrosis and bleb appearance was assessed by using the Moorfields Bleb Grading System. The purpose of this study was to evaluate whether IL6 and PRG4 are potential biomarker of conjunctival fibrosis after filtering glaucoma surgery. Conjunctival biopsies were collected from both study groups and fibrotic fibroblast and non-fibrotic fibroblast primary cell lines were established. The authors found an upregulation of IL6 gene in the fibrotic cell lines and a downregulation of PRG4 in the same cell lines.
Upregulation of IL6 gene in the fibrotic cell lines and a downregulation of PRG4Further studies might show whether these biomarkers may provide sensitive and reproducible information about disease severity and the amount of conjunctival scarring afte glaucoma surgery and furthermore, whether targeting these biomarkers may improve outcome and long-term survival of the bleb.
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