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Curcumin after trabeculectomy: Can it modulate scarring without increasing bleeding? · Glaucoma, Vision & Longevity: Supplements & Science

• 0:00
  SPEAKER_00: Curcumin after trabeculectomy.
• 0:02
  SPEAKER_00: Can it modulate scarring without increasing bleeding?
• 0:05
  SPEAKER_00: Trabeculectomy is a common glaucoma surgery that creates a new drainage pathway for eye fluid.
• 0:11
  SPEAKER_00: Its success depends on keeping the surgical wound, the conjunctiva and underlying tissue from scarring down and closing off.
• 0:18
  SPEAKER_00: Surgeons often use anti-scarring drugs like mitomycin or five fluorooracyl during surgery, but patients and doctors are interested in safer ways to reduce scarring.
• 0:29
  SPEAKER_00: Curcumin, the active ingredient in the spice turmeric, is known for strong anti-inflammatory and antifibrotic actions.
• 0:36
  SPEAKER_00: We review evidence that curcumin can calm inflammation and fibrosis in eye tissues, ways to improve its absorption, and safety issues, bleeding, stomach upset, drug interactions.
• 0:47
  SPEAKER_00: If curcumin is started two weeks after surgery, how would we measure whether it helps?
• 0:52
  SPEAKER_00: We could track outcomes like bleb needling, 5FU injections needed, and pressure control, similar to how glaucoma trials report success.
• 1:01
  SPEAKER_00: 6151 del54 embed image, figure, a plant extracting curcumin from turmeric rhizomes, picture by curcumin extraction plant, CC by 3.0.
• 1:12
  SPEAKER_00: Curcumin is isolated industrially from turmeric at facilities like this.
• 1:17
  SPEAKER_00: Taking turmeric or curcumin means that compound is dissolved and purified before it can affect healing.
• 1:22
  SPEAKER_00: Curcumin is obtained from turmeric root, a yellow spice.
• 1:26
  SPEAKER_00: The powdered spice itself has poor absorption, so most therapeutic preparations use purified curcumin.
• 1:32
  SPEAKER_00: In the lab, curcumin has powerful effects.
• 1:34
  SPEAKER_00: It blocks inflammation by inhibiting molecules like TNFA, NFQB, IL6, and IL8.
• 1:41
  SPEAKER_00: These inflammatory signals normally drive wound healing and scarring, so curcumin's inflammatory action is relevant.
• 1:48
  SPEAKER_00: For example, in cultured eye cells, curcumin, sharply reduces the secretion of the pro-inflammatory cytokines IL6 and IL8.
• 1:58
  SPEAKER_00: In general, curcumin is well documented as an anti-inflammatory agent by blocking signaling pathways that promote inflammation.
• 2:06
  SPEAKER_00: Equally important are curcumin's antifibrotic effects, reducing scar formation.
• 2:11
  SPEAKER_00: In normal wound healing, see diagram below, a growth factor called TGF-Ba1 drives fibroblasts to become myofibroblasts that lay down tight collagen scars.
• 2:21
  SPEAKER_00: In trabeculectomy blebs, excess myofibroblast activity causes failure.
• 2:26
  SPEAKER_00: Laboratory studies show curcumin can interrupt this process.
• 2:29
  SPEAKER_00: For example, in human corneal stromal, keratocyte cells grown in a dish, adding curcumin under proscarring conditions cut the expression of as smooth muscle actin, SMA, a marker of myofibroblast transformation, by about half.
• 2:43
  SPEAKER_00: Correspondingly, curcumin treatment kept these cells from turning into the spindle-shaped scar cells, myofibroblasts.
• 2:50
  SPEAKER_00: Similarly, in orbital fibroblasts, cells behind the eye, curcumin dose-dependently suppressed TGF-b1-induced markers of scarring, CTGF and RSMA, and reduced proangiogenic activity.
• 3:02
  SPEAKER_00: These studies suggest curcumin can blunt the fibrotic response during healing in eye tissues.
• 3:08
  SPEAKER_00: 60xtefty L552 embed image.
• 3:11
  SPEAKER_00: Figure, phases of normal wound healing.
• 3:14
  SPEAKER_00: Curcumin's actions could influence these stages, diagram Oliver Byerman, CC by SA 3.0.
• 3:20
  SPEAKER_00: Wound healing happens in phases inflammation, tissue formation, proliferation, and remodeling.
• 3:26
  SPEAKER_00: Curcumin's anti-inflammatory and antifibrotic effects might speed up safe healing and reduce later scar formation.
• 3:33
  SPEAKER_00: In summary, preclinical evidence shows curcumin dampens the wound healing signals that drive conjunctival scarring.
• 3:40
  SPEAKER_00: This supports the idea that curcumin after trabeculectomy might reduce bleb scarring.
• 3:46
  SPEAKER_00: Clinical trials and eye surgery are lacking, but in other tissues, curcumin has been observed to improve healing and reduce fibrosis.
• 3:54
  SPEAKER_00: Improving curcumin bioavailability and dosing.
• 3:57
  SPEAKER_00: Curcumin is poorly absorbed on its own, so special formulations are used to boost its blood levels.
• 4:03
  SPEAKER_00: One class is phospholipid complexes, often called phytosomes.
• 4:07
  SPEAKER_00: A commercial example is mariva, a curcumin phosphatylcholine complex.
• 4:12
  SPEAKER_00: In healthy volunteers, mariva given at 219 to 376 mg of curcuminoids produced an 18-fold higher total blood curcumin level compared to taking nearly 1,800 mg of unformulated curcumin.
• 4:26
  SPEAKER_00: In other words, the lecithin phospholipid carrier in mariva greatly increased curcumin uptake across cell membranes.
• 4:33
  SPEAKER_00: Other lipid-based carriers, like nanoemulsions, micelles, or liposomes, similarly improve absorption by helping curcumin enter cells.
• 4:42
  SPEAKER_00: Another simple enhancer is piperine, black pepper extract.
• 4:46
  SPEAKER_00: Pyperine inhibits curcumin's breakdown in the gut.
• 4:49
  SPEAKER_00: In one comparison, adding 5 mg of piperine to 2 grams of curcumin increased blood curcumin levels threefold over curcumin alone.
• 4:57
  SPEAKER_00: Even higher doses, up to 24 mg piperine and 4 gram curcum in trials showed large boosts in curcumin levels.
• 5:05
  SPEAKER_00: Because of these tricks, potent curcumin formulations can achieve therapeutic blood levels at much lower doses than plain powder.
• 5:12
  SPEAKER_00: In practice, safe dosing of curcumin has been well studied.
• 5:16
  SPEAKER_00: The NIH notes that oral turmeric extract, standardized to curcumin, is likely safe in recommended amounts for a couple of months.
• 5:25
  SPEAKER_00: Clinical trials have given people up to 8 to 12 grams of curcumin per day without serious side effects.
• 5:31
  SPEAKER_00: Side effects were mild and uncommon.
• 5:34
  SPEAKER_00: For newer high absorption products, much smaller doses can yield similar blood levels.
• 5:39
  SPEAKER_00: For example, 80 to 500 milligrams of a nano curcumin daily can produce blood levels like those achieved with grams of plain curcumin.
• 5:48
  SPEAKER_00: Overall, if using curcumin after surgery, one could choose a high bioavailability form, phytosome, nanoparticle, or added piperine, and expect therapeutic effect from a reasonable oral dose, for instance, 500 to 2000 mg of curcumin equivalent daily, depending on formulation.
• 6:06
  SPEAKER_00: Safety, bleeding risk, gastrointestinal effects, and drug interactions.
• 6:12
  SPEAKER_00: Curcumin is generally well tolerated, but there are some important safety considerations when used after surgery.
• 6:18
  SPEAKER_00: Bleeding risk.
• 6:19
  SPEAKER_00: Curcumin has a mild blood thinning effect.
• 6:22
  SPEAKER_00: In lab studies, it inhibited platelet activation and aggregation, and animal studies confirm anticoagulant effects.
• 6:28
  SPEAKER_00: This means curcumin could increase bleeding risk, especially in patients already on blood thinners, warfarin, aspirin, clopidogrel, etc.
• 6:37
  SPEAKER_00: Indeed, a case report noted a patient on a vitamin K antagonist who ate turmeric had a high INR, excess warfarin effect.
• 6:46
  SPEAKER_00: For surgery patients, the risk of intraocular bleeding is highest early on, but by two weeks the surgical wounds are more stable.
• 6:53
  SPEAKER_00: Still, if a patient is taking a prescription anticoagulant, adding curcumin should be discussed with the doctor.
• 6:59
  SPEAKER_00: For patients on aspirin or similar, curcumin could potentiate the bleeding risk.
• 7:04
  SPEAKER_00: Gastrointestinal effects.
• 7:06
  SPEAKER_00: Curcumin or turmeric can cause mild GI upset in some people.
• 7:10
  SPEAKER_00: According to the NIH, oral turmeric can lead to nausea, stomach pain, acid reflux, diarrhea, or constipation.
• 7:16
  SPEAKER_00: These effects are usually minor.
• 7:18
  SPEAKER_00: In fact, studies report most people tolerate even high doses of curcumin without problems.
• 7:24
  SPEAKER_00: To be safe, curcum supplements are often taken with food.
• 7:28
  SPEAKER_00: If GI upset occurs, taking it with meals or using a delayed release formulation can help.
• 7:34
  SPEAKER_00: Proton pump inhibitors, PPIs themselves, do not have known negative interactions with curcum.
• 7:40
  SPEAKER_00: If anything, a PPI might reduce any stomach irritation.
• 7:43
  SPEAKER_00: Drug interactions.
• 7:45
  SPEAKER_00: Curcum can affect certain drug metabolizing enzymes.
• 7:48
  SPEAKER_00: For example, it can inhibit CYP3A4 in gut cells.
• 7:52
  SPEAKER_00: This means it might alter levels of drugs processed by those enzymes.
• 7:56
  SPEAKER_00: In practice, the main concern is additive blood thinning, see above, or interference with anti-clotting drugs.
• 8:02
  SPEAKER_00: There is no well-known problematic interaction between curcumin and PPIs.
• 8:07
  SPEAKER_00: Most clinicians consider curcumin safe with PPIs, but if a patient is on medications like chemotherapy or immunosuppressants, doctor consultation is prudent.
• 8:17
  SPEAKER_00: In summary, curcumin is regarded as safe for short-term use.
• 8:21
  SPEAKER_00: Side effects are uncommon and usually mild.
• 8:24
  SPEAKER_00: A reasonable precaution is to inform the surgical team if one plans to start curcumin post-op, especially if on anticoagulants.
• 8:32
  SPEAKER_00: Monitoring for any bleeding signs, even bruising or gum bleeding, is wise, though significant bleeding complications from curcumin alone are rare.
• 8:41
  SPEAKER_00: Measuring clinical outcomes.
• 8:43
  SPEAKER_00: If we were to test curcumin after trabeculectomy, we would track standard success metrics used in glaucoma surgery trials.
• 8:50
  SPEAKER_00: The primary goal is lowering and maintaining the intraocular pressure, IOP.
• 8:56
  SPEAKER_00: A commonly used definition of surgical success is an IOP maintained between about 6 and 21 mmHRNX without additional surgery.
• 9:05
  SPEAKER_00: This range can vary by study, but it reflects controlling pressure without overdraining or requiring more surgery.
• 9:11
  SPEAKER_00: We would measure IOP by Goldman applanation tonometry at regular follow-ups.
• 9:16
  SPEAKER_00: Beyond raw IOP numbers, we would count how many eyes required further interventions.
• 9:22
  SPEAKER_00: Key outcomes would include needling rates, how many eyes needed bleb needling, a minor procedure to break scar tissue to revive the bleb, 5 few rescue injections, how often must we inject 5-fluoroorcil in the clinic to prevent scarring?
• 9:37
  SPEAKER_00: Additional medications or surgery, how many eyes needed glaucoma drops or repeat surgery.
• 9:42
  SPEAKER_00: Percentage achieving target IOP, e.g., what fraction met the defined success, IOP 6 to 21, with or without medications.
• 9:51
  SPEAKER_00: These are concrete patient-centered outcomes.
• 9:54
  SPEAKER_00: In effect, we'd compare a curcumin group versus control and see if the curcumin patients have lower needling rates, fewer 5FU injections, and better IOP control over several months.
• 10:05
  SPEAKER_00: For example, one might report at six months, X percent of curcumin patients retained a functioning bleb without needling and the mean IOP reduction in each group.
• 10:14
  SPEAKER_00: Such measures would show if curcumin truly improved long-term success after trabeculectomy.
• 10:20
  SPEAKER_00: Conclusion: in summary, curcumin has properties that could theoretically improve wound healing after trabeculectomy by reducing inflammation and fibrosis.
• 10:29
  SPEAKER_00: Lab studies in eye-related cells demonstrate clear antifibrotic effects.
• 10:34
  SPEAKER_00: The main challenge is getting enough curcumin into the body, but enhanced formulations, phospholipid, nano, piperine, can overcome this.
• 10:43
  SPEAKER_00: Safety data suggests curcumin is well tolerated in the doses one might use postoperatively, with GI upset being rare.
• 10:51
  SPEAKER_00: The potential bleeding risk means we would use caution in patients on anticoagulants, but at two weeks post-op, this risk is lower than immediately after surgery.
• 11:01
  SPEAKER_00: Ultimately, a clinical study could assess whether adding curcumin reduces the need for bleb needling or 5FU injections and helps keep pressures low.
• 11:10
  SPEAKER_00: Until such data exist, the idea of turmeric after TRAB is promising, but not yet proven in patients.
• 11:16
  SPEAKER_00: Sources, research studies and reviews on curcum in ocular cells, bioavailability reports, and safety summaries.
• 11:25
  SPEAKER_00: These provide evidence for the points above.
• 11:27
  SPEAKER_00: All links to sources are available in the text version of this article.
• 11:31
  SPEAKER_00: You can find the full article at VisualFieldTest.com.
• 11:36
  SPEAKER_00: Thanks for listening.
• 11:37
  SPEAKER_00: To check your visual field, click the link at the bottom of this article or visit visualfieldtest.com.