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Editors Selection IGR 7-1

Surgical treatment: Perioperative complications

Comment by Richard Parrish II on:

12531 Accuracy of intraocular pressure measurements in new zealand white rabbit, Lim KS; Wickremasinghe SS; Cordeiro MF et al., Investigative Ophthalmology and Visual Science, 2005; 46: 2419-2423

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In an ongoing series of investigations on how wound healing modification after glaucoma filtering surgery may improve surgical success in animal model, Khaw et al. (?=$lnkABScur?>&page=Abstracts&Abno=488">488) report the in vivo and histologic effects of subconjunctival injections of a broad spectrum inhibitor of matrix metalloproteinase, Ilomastat. Although the sample size was relatively small, 21 New Zealand White rabbits, the length of bleb survival in the Ilomastat group was similar to the mitomycin group. Importantly, the histologic studies demonstrated normal conjunctival morphology after subconjunctival injections of Ilomastat, unlike the hypocelluar subconjunctival changes that developed after exposure to mitomycin. The demonstration that the Ilomastat-treated blebs began to fail on average of 12 days after the last subconjunctival injection, confirms that the effect of the inhibitor is reversible.

Normal conjunctival morphology was demonstrated after subconjunctival injections of Ilomastat

The benefit is likely related to the reduction in collagen synthesis by Tenon's fibroblasts and a reduction in the amount of scar tissue at the drainage site. The possibility of continuing Ilomastat injections in the late postoperative period to maintain IOP control without the tissue damage is promising and justifies further animal studies and hopefully, human clinical trials. The notion of using combination therapy to modulate wound healing at different points in the wound healing cascade remains a potential attractive use of this relatively nontoxic agent.

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