Eyeworld

EW GLAUCOMA 78 February 2015 by Matt Young and Gloria D. Gamat EyeWorld Contributing Writers Postoperative care strategies based on bleb morphology "The wound healing process after glaucoma surgery has a very straight schedule of steps—from homeostasis to remodeling," said Franz Grehn, MD, professor and chairman, University Eye Clinic, University of Wurzburg, Germany, who spoke at the National Health- care Group (NHG) Eye Institute 7th International Ophthalmology Congress in Singapore. "There is a time course for each of those steps, and the time course is rather short. If you are at the remodeling phase, everything is decided and gone. We have to act before that stage, and therefore all things that we do with the bleb have to occur very early." Tina Wong, FRCOphth, senior consultant, glaucoma service, Singapore National Eye Centre, and head of the Ocular Therapeutics and Drug Delivery Research Group, Sin- gapore Eye Research Institute, said, "We cannot direct the wind but we can adjust the sails," when she spoke at the NHG Eye Institute meeting. She discussed how each stage of wound healing could be modulated by different types of therapeutics. "There is a saying that I think summarizes trabeculectomy surgery and its outcomes," she said. "We always want an endpoint where we want a beautiful bleb, but sometimes we have to modulate or guide the wound healing response in order to achieve our goal." Wound healing modulation directs successful glaucoma surgery I n the daily practice of glaucoma surgery, postoperative scarring of the filtering bleb is one of the most crucial factors in determining short- and long- term outcomes. Ultimately, the processes involved in wound healing and tissue repair determine the out- come of glaucoma surgery. For example, conventionally performed trabeculectomy has a failure rate of 30% within 3 months after surgery. This was reported by Diestelhorst et al. in International Ophthalmology in April 1998 based on a retrospective study of 700 eyes. In this particular study, one major focus was to determine the value of postoperative IOP in predicting the outcome of trabeculectomy. But since then, some surgeons have looked into the wound healing process in glaucoma surgery and how this can be modulated for better outcomes. Wound healing modulation Postop care strategies based on bleb morphology have been found to help facilitate early recognition of failing bleb patterns and thereby promote more timely and aggressive intervention. An inflamed and vascularized bleb with a high risk of failure Source: Tina Wong, FRCOphth Encapsulated bleb Source: Franz Grehn, MD A diffuse filtering bleb Source: Tina Wong, FRCOphth Cork screw vessels Source: Franz Grehn, MD continued on page 80

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