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The problem of wound healing at the episcleral level is still an issue, because it seems that a considerable IOP-lowering effect can only be accomplished with filtering procedures. In this review, the pharmacological background of the development of suramin as an agent to be used during trabeculectomy in glaucoma patients is described. Suramin is a substance that specifically inhibits the action of growth factors on target cells by binding to their receptors. In tissue studies it was found that suramin is able to inhibit the production of collagen by Tenon fibroblasts at levels that are not toxic to the cells. Further experiments with rabbits showed, that at high concentrations of the substance, the fistula can be held open for a time period similar to that of a high concentration of mitomycin. Thus, the efficacy of the substance was demonstrated. Further more, in a group of selected patients with end-stage glaucomatous disease, suramin applied during surgery and afterwards was able to increase the survival rate of the filtering blebs. No toxic side-effects of the substance suramin were noted. Mitomycin, applied at various concentrations, is the gold standard for the use during trabeculectomy. Mitomycin is currently a good option for repeat-trabeculectomies and for all other complicated forms of glaucoma. The use of mitomycin for infants and in primary procedures is under discussion. Side-effects are frequent and may be severe including chronic hypotony and blebitis or endophthalmitis.