青光眼滤过性手术后抗瘢痕化治疗的研究进展

Progress on anti-fibrotic therapy after glaucoma filtration surgery

滤过性手术作为抗青光眼的主要术式在临床上得到广泛应用，但术后复发率高，其主要原因是术区成纤维细胞增生，滤过道瘢痕化使房水流出受阻。为了提高手术成功率，一些抗瘢痕化药物越来越多地应用于青光眼滤过手术的实验与临床研究中，但这些药物也有一定的毒副作用和并发症。随着对瘢痕化过程的认识深入和医疗技术的发展，人们正在寻找抗瘢痕化效率高、副作用少、安全性好的抗瘢痕化药物，以提高青光眼滤过术的成功率。近年研究的新型抗瘢痕化药物包括抗血管内皮生长因子抗体、吡非尼酮、苏拉明、1-磷酸鞘氨醇抗体、辛二酰苯胺异羟肟酸、基质金属蛋白酶抑制剂、microRNA、基因治疗、纳米药物等。目前对于新型抗瘢痕化药物的研究仍处于基础阶段，这些新型抗瘢痕药物及方法应该具有安全无毒等特点，对于其具体给药剂量、给药时间及次数等药代动力学的探索仍具有较大的潜在研究价值。

Filtration surgery is still the major operative intervention to glaucoma. The failure （ recur- rence） rate of the surgery remains high due to the scarring of the filtration zone as the result of fibroblast hy-perplasia. To improve the success rate of the surgery, a variety of anti-fibrotic agents have been used in the clinic, which may be potentially accompanied by unwanted adverse reaction/side effect and complications. With better understanding of the scarring process, progress on the development of anti-scarring agents with high efficiency but less side effects has achieved to improve the outcome of filtration surgery. Novel anti-fi- brotic agents are under investigation recently, including anti-vascular endothelial growth factor, piffenidone, suramin, sphingosine-l-phosphate antibody, suberoylanilide hydroxamic acid, tissue inhibitor of metallopro-teinase, microRNA, gene therapy and nano-drugs. The researches regarding the effectiveness and safety of these novel agents are still preliminary. Further studies on the pharmacokinetics of these drugs needs to be carried out, including the dosage, timing and frequency of drug administration.