Wundheilungsmodulation nach filtrierenden Glaukomoperationen: Was kommt nach TGF-β?

Zusammenfassung

Die Vernarbung des operativ geschaffenen Kammerwasserabflusswegs ist das Hauptproblem der filtrierenden Glaukomchirurgie. Zytostatika können die Vernarbung hemmen, doch schränken unerwünschte Wirkungen ihren Einsatz ein. In dieser Übersicht werden Mechanismen und Besonderheiten der Wundheilung nach filtrierenden Glaukomoperationen erörtert und neuere Entwicklungen im Bereich der Wundheilungsmodulation vorgestellt. Der Wachstumsfaktor TGF-β spielt eine zentrale Rolle in der Wundheilung und Narbenbildung, weshalb ein Abfangen von TGF-β und die spezifische Blockade nachgeschalteter intrazellulärer Signale eine verbesserte Wundheilungsmodulation ermöglichen können. Zahlreiche neue Substanzklassen befinden sich in der präklinischen Erprobung und begründen die Hoffnung auf verbesserte Behandlungsmethoden durch eine erweiterte postoperative Kombinationstherapie.

Abstract

Conjunctival scarring remains the major problem in filtering glaucoma surgery. Antimetabolites afford a reduction of scar formation, but considerable side effects limit their application. Here, we review the mechanisms and peculiarities of wound healing following glaucoma surgery and report on new developments in the field of wound healing modulation. The growth factor TGF-β has a central role in wound healing and scarring. Therefore, novel concepts of wound healing modulation comprise scavenging of TGF-β and specific inhibition of disinct downstream intracellular signalling pathways. Several compounds have entered preclinical evaluation and offer new potential to modulate scarring in future combination therapies.

Schlüsselwörter

Glaukom - Wundheilung - TGF-beta

Key words

glaucoma - wound healing - TGF-beta

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