On the use of curcumin as a multimodal antifibrotic agent for glaucoma surgery
Nicholas M. Pfahler
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Purpose: Excessive wound healing is a primary cause of surgical failure following glaucoma filtration surgery. This chapter reviews the success of current management strategies for postoperative wound healing, examines several alternative therapies in development, and proposes the use of curcumin as a novel and multimodal therapy to reduce excessive postoperative scarring following glaucoma filtration surgery.
Methods: To determine risk factors associated with surgical failure in glaucoma filtration surgery, a review was conducted of large clinical studies reporting significant hazard ratios for factors associated with surgical failure. To determine rates of surgical failure in trabeculectomy surgery using metabolites as intraoperative antifibrotics, a review was conducted of clinical studies in which trabeculectomy was performed in patients without previous intraocular surgery and surgical success was defined as intraocular pressure ≤ 21 mmHG or a reduction ≥ 20-30% from baseline. A further review was conducted to explore the mechanisms of wound healing and assess potential alternative antifibrotic agents. A search was performed of in vitro, animal, and human studies testing the effects of curcumin in wound healing.
Results: Preoperative clinical and demographic risk factors associated with complications and surgical failure following glaucoma filtration surgery include age, race, diabetes, secondary glaucoma, history of intraocular surgery, and use of topical glaucoma medications. Surgical failure remains common in trabeculectomy surgeries performed using metabolites as intraoperative antifibrotics. Despite this, no alternative or adjunctive therapy has consistently outperformed the use of metabolites alone in human trials. In vitro, animal, and human studies show that curcumin, a polyphenol derived from turmeric, targets all four phases of the wound healing process and may be a safe and viable anti-inflammatory and antifibrotic agent used to reduce postoperative scarring following glaucoma filtration surgery.
Conclusions: The use of intraoperative antifibrotics to control wound healing is not always effective and carries additional risks. Alternative or adjunctive antifibrotic therapies, however, have not proven any more effective. It is proposed that the diverse mechanisms of curcumin make it a viable alternative or adjunctive therapy to target excessive wound healing, reduce postoperative scarring, and improve outcomes following glaucoma filtration surgery.
New Concepts in Glaucoma Surgery Series: Volume 1, pp. 71-84 #5
Edited by: John R. Samples and Iqbal Ike K. Ahmed
© Kugler Publications, Amsterdam, The Netherlands
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