Most patients are initially treated with topical medication, but often this option is insufficient to reach the appropriate IOP, or is not tolerated due to side effects. Furthermore, in many third world countries medications are too costly and a one-time intervention is necessary. Also, low patient compliance with medications is a serious problem in glaucoma. Thus frequently, surgery becomes necessary.
The most common surgical procedure used in open-angle glaucoma is a trabeculectomy (also known as filtration surgery). This procedure is invasive, requires years of surgical experience and is associated with relatively high complication and failure rates as well as prolonged visual instability. Healing and scarring are the main obstacles for long term IOP control after filtration surgery. Antimetabolites such as 5-Fluorouracil (5-FU) and Mitomycin C (MMC) are frequently used to reduce scarring and improve drainage. The use of these substances is potentially hazardous and requires high expertise to prevent overfiltration and hypotony. Therefore there is a need to widen the existing surgical options for Glaucoma.