Effect of intravitreal plasmin on vitreous removal through a 25-gauge cutting system in the rabbit in vivo

Hermel, Martin; Prenner, Jonathan L.; Alabdulrazzak, Motaz; Dailey, Wendy; Hartzer, Michael K.

doi:10.1007/s00417-008-1000-7

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…The 23-G vitrectomy allows for increased comfort, faster healing time, reduced corneal astigmatism, shorter surgical time, rapid postoperative and visual recoveries, less inflammation and less disruption to the conjunctiva than with 20-gauge procedures [ 26 , 27 ]. The smaller port size of the instruments increases the ability to remove vitreous with very little traction or to remove epiretinal membranes without risking incarceration of the retina in the port.…”

Section: Discussionmentioning

confidence: 99%

23 Gauge pars plana vitrectomy for the removal of retained intraocular foreign bodies

et al. 2015

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BackgroundTo evaluate the morpho-functional outcomes and safety of transconjuctival 23-gauge pars plana vitrectomy(PPV) for removal of intraocular foreign bodies (IOFBs).MethodsA retrospective study of 36 consecutive cases (mean age; 34,2 ± 10,9 years (between 15 and 60), 27 M,9 F) of 23-G PPV for the removal of IOFBs during the period of April 2009 and December 2011 and followed 9,4 ± 6,4(2–27) months were conducted. Visual outcomes, slit lamp biomicroscopy, intraocular pressure (IOP), and posterior segment visualization by indirect ophthalmoscopy, A-B mode ultrasonography, and computed orbital tomography were performed for all cases. Main outcomes including anatomic and visual outcomes, and both intraoperative and postoperative complications were recorded.ResultsOf the 36 cases available for the study, the IOFBs (size range, 3 to 12 mm) could be removed in all eyes. Mean preoperative LogMAR BCVA was 1.44 ± 138 (range, 1.00 to 0.00) and mean postoperative LogMAR BCVA at final visit was 0,78 ± 0,98 (range, 1.00 to 0.00). (P = 0,007) Anatomic success was obtained in 97.2 % of eyes. 16 patients needed primary wound repair due to the leakage in insertion sites before the PPV, however remaining 20 cases were not. Fibrin reaction was seen in 8 (22.2 %) patients in early postoperative period, intraocular pressure elevation was detected in 12 (33.3 %) patients in which the silicone oil was used as an intravitreal tamponade, one patient with silicone oil tamponade developed band keratopathy and phthisis bulbi.Conclusions23-Gauge PPV is a feasible, effective approach in the surgical management of the patients with posterior segment intraocular foreign bodies.

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Section: Discussionmentioning

confidence: 99%

23 Gauge pars plana vitrectomy for the removal of retained intraocular foreign bodies

et al. 2015

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“…This may facilitate vitreous removal, as corroborated by some studies 37. For instance, Hermel et al37 described a 27% increase in vitreous removal through a 25-gauge vitrectomy system in rabbit eyes injected with plasmin when compared with no preoperative injection.…”

Section: Resultsmentioning

confidence: 75%

“…MMP-2 has an affinity for various collagens, including basement membrane type IV, and it is thought to play an important role in vitreous liquefaction 28,55–57. This may facilitate vitreous removal, as corroborated by some studies 37. For instance, Hermel et al37 described a 27% increase in vitreous removal through a 25-gauge vitrectomy system in rabbit eyes injected with plasmin when compared with no preoperative injection.…”

Section: Resultsmentioning

confidence: 87%

Profile of ocriplasmin and its potential in the treatment of vitreomacular adhesion

Stefanini¹,

Maia²,

Falabella³

et al. 2014

OPTH

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The recent approval by the US Food and Drug Administration of ocriplasmin for the treatment of symptomatic vitreomacular adhesion (VMA), often associated with vitreomacular traction (VMT) and macular hole (MH), has brought new attention to the field of pharmacologic vitreolysis. The need for an enzyme to split the vitreomacular interface, which is formed by a strong adhesive interaction between the posterior vitreous cortex and the internal limiting membrane, historically stems from pediatric eye surgery. This review summarizes the different anatomic classifications of posterior vitreous detachment or anomalous posterior vitreous detachment and puts these in the context of clinical pathologies commonly observed in clinical practice of the vitreoretinal specialist, such as MH, VMT, age-related macular degeneration, and diabetic macular edema. We revisit the outcome of the Phase II studies that indicated ocriplasmin was a safe and effective treatment for selected cases of symptomatic VMA and MH. Release of VMA at day 28 was achieved by 26.5% of patients in the ocriplasmin group versus 10.1% in the placebo group (P<0.001). Interestingly, for MHs, the numbers were more remarkable. Predictive factors for successful ocriplasmin treatment were identified for VMT (VMA diameter smaller than 1,500 μm) and MH (smaller than 250 μm). In comparison with the highly predictable outcome after vitrectomy, the general success rate of ocriplasmin not under clinical trial conditions has not fully met expectations and needs to be proven in real-world clinical settings. The ocriplasmin data will be compared in the future with observational data on spontaneous VMA release, will help retina specialists make more accurate predictions, and will improve outcome rates.

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“…In the former model, a pharmacologic agent administered preoperatively acts to either induce vitreous liquefaction, allowing for more rapid vitreous removal, or weaken the vitreorentinal adhesion, allowing for greater ease of mechanical PVD induction with a cleaner vitreoretinal separation 15,64–67. More rapid vitreous removal translates into shorter surgical times15,25,68 and possibly an increased ability to employ smaller gauge instrumentation,69,70 which are associated with reduced postoperative recovery times 71,72. Weakening of the vitreorentinal adhesion allows mechanical PVD creation without the use of high suction, which reduces the risk of iatrogenic tears73,74 and permits the use of smaller gauge instrumentation not capable of achieving such high levels of aspiration 69,75,76.…”

Section: Indications For Pharmacologic Vitreolysismentioning

confidence: 99%

Emerging nonsurgical methods for the treatment of vitreomacular adhesion: a review

Schneider¹,

Johnson²

2011

OPTH

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With the dissemination of optical coherence tomography over the past two decades, the role of persistent vitreomacular adhesion (VMA) in the development of numerous macular pathologies – including idiopathic macular hole, vitreomacular traction syndrome, cystoid and diabetic macular edema, neovascularization in diabetic retinopathy and retinal vein occlusion, exudative age-related macular degeneration, and myopic traction maculopathy – has been established. While invasive vitreoretinal procedures have long been utilized to address complications related to these disorders, such an approach is hampered by incomplete vitreoretinal separation and vitreous removal, surgical complications, and high costs. In light of such limitations, investigators have increasingly looked to nonsurgical means for the treatment of persistent pathologic VMA. Chief among these alternative measures is the intravitreal application of pharmacologic agents for the induction of vitreous liquefaction and/or vitreoretinal separation, an approach termed pharmacologic vitreolysis. This article aims to review the available evidence regarding the use of pharmacologic agents in the treatment of VMA-related pathology. In addition, a discussion of vitreous molecular organization and principles of physiologic posterior vitreous detachment is provided to allow for a consideration of vitreolytic agent mode of action and molecular targets.

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Effect of intravitreal plasmin on vitreous removal through a 25-gauge cutting system in the rabbit in vivo

Abstract: Intravitreal plasmin increases the rate of vitreous removal in rabbits.

Cited by 6 publications

References 20 publications

23 Gauge pars plana vitrectomy for the removal of retained intraocular foreign bodies

23 Gauge pars plana vitrectomy for the removal of retained intraocular foreign bodies

Profile of ocriplasmin and its potential in the treatment of vitreomacular adhesion

Emerging nonsurgical methods for the treatment of vitreomacular adhesion: a review

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