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

Abstract

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.

Cryotherapy-Induced Release of Epiretinal Membrane Associated With Retinal Vasoproliferative Tumor

“…27 Other management strategies involve pharmacological vitreolysis to induce vitreous liquefaction and posterior vitreous detachment. [27][28][29] For VPT-related ERM, there is debate regarding the most efficacious therapy. In this study, we explored the role of cryotherapy as the primary treatment for VPT and its role in secondarily causing release of ERM.…”

Ocriplasmin zur Behandlung der symptomatischen vitreomakulären Traktion mit und ohne Makulaforamen

“…Die intravitreale Therapie mit Ocriplasmin (Jetrea®) zur pharmakologischen Vitreolyse ist für die Behandlung einer symptomatischen VMT (≤ 1500 µm) ohne und mit MF (≤ 400 µm) zugelassen [2,8,14,18,20,25]. Die kombinierten Daten der Phase-3-Studien (MIVI 6/7) ergaben hinsichtlich der Lösung der VMT am Tag 28 nach IVOM mit Ocriplasmin (26,5 %) einen signifikanten Unterschied im Vergleich zur Placebobehandlung (10,1 %) [23].…”

“…lären vitreoretinalen Übergang, die durch Laminin und Fibronektin vermittelt wird, enzymatisch zu lösen [8, 14,15,18,21,23,25].…”

Review and Perspectives on Pharmacological Vitreolysis

“…Although being a truncated form, it retains the same proteolytic activity of plasmin, targeting major components of the vitreoretinal interface such as fibronectin and laminin. Moreover, it has some advantages over plasmin, including the following: (1) it is quarter the size of plasmin (22 vs. 88 kDa), which permits a greater penetration of vitreous and epiretinal tissues; (2) being generated by means of recombinant techniques, it ensures product sterility and eliminates the risk of microbial contamination associated with blood derivatives; (3) it permits the avoidance of the rigorous and expensive preparation of autologous plasmin, and (4) it is more stable than plasmin, which simplifies storage and timing of administration [61] . Ocriplasmin works via a two-step mechanism involving vitreoretinal separation and vitreous liquefaction.…”