Prof Tina Wong

Synopsis: Surgical options have long been historically reserved for patients with either advanced stages of the disease and/or ineffective intraocular pressure (IOP) control with medications or laser associated with signs of progressive loss of vision. Trabeculectomy surgery is a highly effective operation in lowering the IOP but can have risks of failure, mainly from the wound healing response and scarring, as well as a lifetime risk of blindness as a result of mitomycin C being prescribed as the gold standard of care since the late 1980s. While over the past four decades we have witnessed tremendous improvements in surgical techniques, as well as more recently, the emergence of minimally invasive devices further adding to our surgical armamentarium, the anti-fibrotic management in bleb forming glaucoma surgeries have largely remained stagnant and unchanged. With the increasing life span in the world population and greater accessibility to surgery at earlier stages of disease, we are witnessing a significant increase in the number of patients undergoing surgery. For most countries, bleb forming surgeries remain an important surgical option for achieving target IOPs of low teens to single digits. Unpredictable scarring is a serious complication that hampers success in achieving the goal of long-term IOP control. Finding an alternative to mitomycin C remains elusive and drives continued efforts interrogating the biological processes fuelling this obstacle. In this lecture, new emerging concepts and ongoing research directions will be discussed that are striving to deliver safer anti-scarring strategies.