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Plasmin vitrectomy

Anna E Mec-Słomska, Joanna Adamiec-Mroczek, Ewa Kuźmicz, Marta Misiuk-Hojło
Vitreoretinal interface pathologies, such as vitreomacular traction syndrome, epiretinal membranes and macular holes are sight-threatening conditions and one of the important causes of vision defects and vision loss. To this date, vigilance with observation of how the vitreomacular traction resolves, or vitreoretinal surgery in more severe cases, were the only treatment options. Recent rapid progress in ophthalmology, especially in diagnostic and visualization techniques, provided better insight into the mechanisms taking place on the vitreoretinal surface, which enabled a more accurate selection of treatment options...
May 2017: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Yoshihiro Yonekawa, Benjamin J Thomas, Aristomenis Thanos, Bozho Todorich, Kimberly A Drenser, Michael T Trese, Antonio Capone
PURPOSE: To discuss the latest advances and controversies in the diagnosis and care of infants with retinopathy of prematurity (ROP). METHODS: Literature review. RESULTS: Retinopathy of prematurity remains a major global issue. Industrialized nations now treat profoundly premature infants with posterior and aggressive disease, and middle-income nations are experiencing ROP epidemics. Remote digital imaging may address the decreasing ratio of ROP providers to premature infants, in addition to improving patient care...
December 2017: Retina
Stanislao Rizzo, Daniela Bacherini
Vitreomacular traction (VMT) is one of many possible factors involved in the etiology of diabetic macular edema (DME). Pharmacologic vitreoretinal separation is a potential alternative to vitrectomy for VMT in diabetic retinopathy. Small case series have been published on the use of enzymatic vitreolysis in tractional DME, and demonstrate that the enzymatic release of the posterior vitreous cortex is more likely following the injection of plasmin enzyme. Further prospective and randomized clinical trials are necessary to evaluate the clinical relevance of ocriplasmin for vitreomacular traction in diabetic retinopathy, and additional studies are needed to determine more accurately which patients might benefit most from this treatment and how often and at what concentration ocriplasmin should be administered...
2017: Developments in Ophthalmology
Yung-Sung Lee, Nan-Kai Wang, Yen-Po Chen, Kuan-Jen Chen, Yih-Shiou Hwang, Chi-Chun Lai, Wei-Chi Wu
PURPOSE: To evaluate the efficacy and safety of using plasmin-assisted vitrectomy in pediatric patients with vitreoretinal diseases. METHODS: We prospectively recruited children aged 16 years or younger who presented with vitreoretinopathies and underwent plasmin-assisted vitrectomy between 2012 and 2013. The main outcome measure was the induction of posterior vitreous detachment (PVD) using a suction power of 200 mm Hg or less during surgery. RESULTS: Eleven eyes of 11 patients (mean age: 3...
2016: Ophthalmic Research
Francisco Gómez-Ulla, Manuel F Bande, Maximino Abraldes
INTRODUCTION: Ocriplasmin is a human plasmin fragment indicated for vitreomacular traction treatment. With its increasing use, several reported cases have suggested possible toxicity to the retina. CASE: We describe a case of a 55-year-old woman with symptomatic vitreomacular traction and a macular hole in the right eye who showed an acute decrease in visual acuity after an intravitreal ocriplasmin injection. Spectral-domain optical coherence tomography showed an alteration in the ellipsoid layer...
December 2015: Documenta Ophthalmologica. Advances in Ophthalmology
Luxi Li, Hongjun Du, Manhong Li, Yannian Hui
Incomplete perifoveal posterior vitreous detachment (PVD) associated with abnormal vitreomacular adhesion (VMA) can cause vitreomacular traction (VMT) and macular hole (MH) formation, which require vitrectomy treatment. Pharmacologic vitreolysis, which is intravitreal injection with vitreolytic enzymes to resolve VMA, may be used as an alternative therapy.Ocriplasmin, formerly known as microplasmin, is a recombinant truncated form of plasmin with proteolytic activity against fibronectin and laminin.It was recently approved for VMA treatment in the European Union and USA...
February 2015: [Zhonghua Yan Ke za Zhi] Chinese Journal of Ophthalmology
F J Rodríguez-Hurtado, M P Garrido Collado, V César Delgado Ceballos
PURPOSE: To determine whether intravitreal injection of autologous plasmin enzyme (APE) is effective in vitreomacular traction syndrome (VMTS) by improving visual acuity and restoring macular morphology. METHODS: A prospective study of 11 consecutive patients diagnosed with VMTS in the Ophthalmology Department from January to May, 2011. INCLUSION CRITERIA: best corrected visual acuity (BCVA) less than 0.5, and vitreomacular attachment in foveal area resulting in macular thickness>250 microns diagnosed by optical coherence tomography (Cirrus OCT, Carl Zeiss Meditec, Inc, Oberkochen, Germany)...
June 2015: Archivos de la Sociedad Española de Oftalmología
Tetsu Asami, Shu Kachi, Usama Ali Mohamed, Yasuki Ito, Hiroko Terasaki
We conducted a study of the effect of intravitreal plasmin on retinal thickness in rabbits. Forty rabbit eyes were injected with 0.4, 1, 2, and 5 IU of plasmin (8 eyes/group). The same volume of BSS-plus(®) was injected in control eyes. Four eyes in each group underwent vitrectomy 60 minutes after the injections. The retinal thickness was measured in optical coherence tomographic (OCT) images before, 30 minutes, and 1 week after the injection. To study the effect of hyperosmolarity, 4 eyes received an injection of mannitol solution whose osmolarity was the same as the plasmin solutions...
February 2015: Nagoya Journal of Medical Science
Mengyu Zhang, Youxin Chen
Ocriplasmin is a recombinant truncated form of human serine protease plasmin with proteolytic activity to induce vitreous liquefaction and weaken vitreomacular adhesion, thereby facilitating posterior vitreous detachment and acting as a potential alternative to replace the more traumatic vitrectomy which can result in incomplete vitreoretinal separation. Intravitreal ocriplasmin for symptomatic vitreomacular adhesion has been systematically evaluated in clinical trials. Ocriplasmin at the recommended dose of a single 125 µg intravitreal injection has recently been approved for the treatment of symptomatic VMA in the USA and EU...
November 2014: [Zhonghua Yan Ke za Zhi] Chinese Journal of Ophthalmology
Li-Jun Shen, Yi-Qi Chen, Dan Cheng, Chaote Zhang, Lu Jiang, Mingsheng Hong, Qian-Yan Kang
PURPOSE: To evaluate the feasibility of retinal vein bypass surgery for induced branch retinal-vein occlusion (BRVO) in the living porcine eye. METHODS: Fifteen minipigs were used in the study. Seven days before vascular surgery, hyaluronidase and plasmin were intravitreally injected for induction of posterior vitreous detachment. Aspirin and warfarin were oral administered daily starting 5 d prior to vascular surgery for anti-coagulation. The minipigs were anethetized with an intraperitoneal injection of 300 mg/kg chloral hydrate for intravitreal injection procedure and vascular surgery...
2016: Current Eye Research
Anand Vinekar, Polly Quiram, Newman Sund, Jon Wilson, Antonio Capone
PURPOSE: To report the surgical outcome, histopathology, immunohistochemistry, and optical coherence tomographic findings in a case of bilateral combined hamartoma of retina and retinal pigment epithelium. METHOD: Bilateral heterologous plasmin-assisted lens-sparing vitrectomy was performed. The surgical specimen underwent histopathological and immunohistochemical analysis. PATIENT: An 18-month-old male child with bilateral combined hamartoma of the retina and retinal pigment epithelium...
2009: Retinal Cases & Brief Reports
Wei-Chi Wu, Kimberly A Drenser, Michael T Trese
PURPOSE: To report a new surgical technique for repair of rhegmatogenous retinal detachments in children. METHODS: This study is an interventional case series. Combined scleral buckling and enzymatic vitrectomy by autologous plasmin was performed in three patients who presented with rhegmatogenous retinal detachment. Anatomic and functional outcomes as well as surgical complications were recorded. RESULTS: Following combined surgery, all patients achieved retinal reattachment...
2008: Retinal Cases & Brief Reports
Manuel Diaz-Llopis, Patricia Udaondo, Jose Maria Millán, J Fernando Arevalo
The aim of this paper is to determine the role of enzymatic vitrectomy performed by intravitreal injection of autologous plasmin enzyme (APE) in the management of diabetic retinopathy and diabetic macular edema (DME). Diabetic patients with proliferative diabetic retinopathy or DME and evident posterior hyaloid adherence to the retinal surface were included. All cases were treated with an initial intravitreal injection of APE and reevaluated one month later, measuring changes in best-corrected visual acuity (BCVA), macular thickness and the status of the posterior hyaloid...
December 15, 2013: World Journal of Diabetes
Thomas Bertelmann, Thomas Stief, Reka Bölöni, Stephan Schulze, Yaroslava Wenner, Walter Sekundo, Stefan Mennel
Plasmin is the key enzyme of fibrinolysis. Plasmin-alpha2-antiplasmin (PAP) complexes are biomarkers of fibrinolysis activation. The purpose of our investigation was to evaluate the activity of fibrinolysis in normal human eyes, that is in eyes without blood-retina barrier breakdown (BRB), which has not been investigated so far. Twenty-two vitreal samples were harvested at the beginning of a standard 23-gauge three-port pars plana vitrectomy for macular pucker removal, macular hole closure or vitreal floater removal from the central vitreous body...
April 2014: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
M Codenotti, G Maestranzi, U De Benedetto, G Querques, P Della Valle, L Iuliano, G Fogliato, A D'Angelo, F Bandello
PURPOSE: To evaluate the effects of intravitreal autologous plasmin enzyme (APE) in patients with focal vitreomacular traction (VMT). METHODS: APE was obtained by incubation of patient-derived purified plasminogen with streptokinase, and intravitreally injected 5-12 days later. Twenty-four hours after injection, in case of incomplete VMT release, a pars plana vitrectomy was performed. The hyaloid internal limiting membrane adherence and removal of the posterior hyaloid were intraoperatively evaluated...
January 2013: Eye
S Chien Wong, Antonio Capone
PURPOSE: To discuss the potential role of microplasmin (ocriplasmin) as a surgical adjunct to vitrectomy in pediatric vitreoretinopathies. METHODS: Literature review of the laboratory and clinical evidence to date for the use of both autologous plasmin enzyme as an adjunct to vitrectomy and more recently recombinant microplasmin (ocriplasmin) as monotherapy for focal vitreomacular traction in adults. RESULTS: Autologous plasmin enzyme is currently being used as a surgical adjunct to vitrectomy, with supporting Levels 2 and 3 published evidence in a range of pediatric vitreoretinopathies including Stage 5 retinopathy of prematurity and congenital X-linked retinoschisis...
February 2013: Retina
Boris V Stanzel, Zengping Liu, Ralf Brinken, Norbert Braun, Frank G Holz, Nicole Eter
PURPOSE: To develop a surgical technique for the subretinal implantation of cell carriers suitable for the transplantation of cultured retinal pigment epithelium (RPE) in a preclinical animal model. METHODS: Cell carriers were porous 10-μm-thick polyester membranes. A custom-made shooter instrument consisted of a 20-gauge metallic nozzle with a nonstick plunger. Fetal human RPE cultures were used for vitality assessment during instrument handling. Transvitreal subretinal implantation of carriers without RPE was performed in 31 rabbits after vitrectomy...
January 2012: Investigative Ophthalmology & Visual Science
Amal M Elbendary, Mohamed M Elwan, Hanan A Azzam, Doaa R Eldeeb
PURPOSE: To assess preoperative factors associated with postoperative posterior vitreous detachment (PVD) following intravitreal autologous plasmin injection in diabetic macular edema associated with vitreomacular traction. METHODS: Twenty-five eyes with diabetic macular edema associated with vitreomacular traction as documented with optical coherence tomography were included. Approximately 0.2 IU/0.2 ml of autologous plasmin was injected intravitreally. Condition of the posterior vitreous face (degree of detachment, thickness, reflectivity, and diameter of attached vitreous base) was evaluated preoperatively and postoperatively up to 3 months...
June 2011: Current Eye Research
Patricia Udaondo, Manuel Díaz-Llopis, Salvador García-Delpech, David Salom, Francisco J Romero
OBJECTIVES: To evaluate the effects and safety of intravitreal injections of autologous plasmin enzyme (APE), without vitrectomy, as a treatment for macular edema secondary to branch retinal vein occlusion. DESIGN: Prospective, comparative, interventional case series. METHODS: Patients were recruited and enrolled consecutively from February 1 through October 31, 2008, at the Retina Unit of the Hospital General Universitario, Valencia, Spain...
March 2011: Archives of Ophthalmology
Ahmed M Abu El-Asrar, Hani S Al-Mezain
Diabetic retinopathy remains a major cause of worldwide preventable blindness. The vitreo-retinal interface plays a critical role in the pathogenesis of diabetic retinopathy. The term pharmacologic vitreolysis refers to the use of enzymes to liquefy the vitreous gel, and to induce posterior vitreous detachment (PVD). Intravitreal ovine hyaluronidase injection was effective in clearing vitreous hemorrhage. Several human case series demonstrated that intravitreal injection of autologous plasmin enzyme was a safe and effective adjunct to vitreous surgery for the treatment of diabetic macular edema and proliferative diabetic retinopathy...
March 1, 2011: Current Pharmaceutical Biotechnology
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