Antifibrotics in glaucoma surgery: current practices and future directions

PURPOSE OF REVIEW: This review aims to cover the current landscape of antifibrotics used in glaucoma surgery and discuss developing antifibrotic agents. This review will inform the reader of new antifibrotic agents in development, clinical trials and clinical use that may alter the standard of care in glaucoma surgery in the near future. RECENT FINDINGS: Mitomycin-C (MMC) remains the most commonly used antifibrotic in glaucoma surgery to date with expanding use beyond trabeculectomy into the world of minimally invasive bleb forming surgeries. MMC continues to cause similar side effects due to toxicity which is a main driver of innovation. Newer antifibrotic agents are under investigation at all stages of drug development from bench research to clinical use. Familiar agents such as bevacizumab, sodium hyaluronate, and matrix metalloproteinases have shown noninferior success rates to MMC when used as adjunct agents with filtration surgery. Many other antifibrotics agents are being investigated with mixed results. SUMMARY: While MMC remains the gold standard antifibrotic agent for glaucoma surgery, there are numerous antifibrotic agents in development with safer side effect profiles and similar success rates that may change the surgical practice of glaucoma.