Intravitreal ocriplasmin: A breakthrough in the treatment of vitreomacular traction?

Abstract

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. Development of ophthalmic pharmacological procedures, such as treatment of vitreomacular traction syndrome with ocriplasmin, constitutes an innovative breakthrough in ophthalmology. The enzyme is a genetically engineered form of human plasmin, a component of blood coagulation cascade that has been envisioned for human therapy since 1950s. It has never been used for vitreolysis in ophthalmology before. The aim of this review is to analyze and compare therapeutic options for symptomatic vitreomacular adhesion and vitreoretinal traction, with particular emphasis on microplasmin. We reviewed the results of recent studies comparing ocriplasmin to other widespread treatment options, such as pars plana vitrectomy.

Mutational Analysis of Ocriplasmin to Reduce Proteolytic and Autolytic Activity in Pichia pastoris

“…Vigilant monitoring and pars plana vitrectomy constitute standard procedures for managing symptomatic vitreomacular adhesion [ 1 , 3 ]. Given the risk of damage to the retina caused by the surgery [ 7 ], proteolytic enzymes such as plasmin have been examined for the enzymatic release of retinal traction [ 8 ].…”

“…Vitreomacular adhesion can be treated and full-thickness macular holes are closed as a result of the activities of the recombinant protease ocriplasmin against the components of the extracellular matrix that form part of the vitreoretinal interface [ 3 , 9 – 11 ]. Two pivotal Phase III trials, including ocriplasmin for Intravitreous Injection-Traction Release without Surgical Treatment [MIVI-TRUST], confirmed the efficacy and safety of ocriplasmin in treating symptomatic vitreomacular adhesion.…”

Pars Plana Vitrectomy for Resistant Cystoid Macular Edema

“…Traction at the Muller cells causes strain and the blood retinal barrier collapses resulting in dissociation of retina and RPE, consequently leakage and edema. 1 Common causes of CME are diabetes, pars plana uveitis, retinitis pigmentosa, Irvine gas syndrome, laser photocoagulation, intraocular pressure lowering procedures, and certain drugs like prostaglandin E2 analogues. 2 Most cases resolve within four months.…”

Patient-Reported Visual Function From the Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion, Including Macular Hole (Oasis) Study

“…S ymptomatic vitreomacular adhesion (VMA) or vitreomacular traction can cause anatomical disturbances of the macula and formation of macular hole. [1][2][3] Reduced visual acuity and visual distortion, such as metamorphopsia, can significantly affect quality of life and is associated with symptomatic VMA. 4 The current treatment options for symptomatic VMA, which depend on the disease stage and progression, include watchful waiting, pharmacologic vitreolysis, and pars plana vitrectomy.…”

“…4 The current treatment options for symptomatic VMA, which depend on the disease stage and progression, include watchful waiting, pharmacologic vitreolysis, and pars plana vitrectomy. 2,5 Although symptomatic VMA resolves spontaneously in some patients (10%-35% of cases), if left untreated, symptomatic VMA can progress and may lead to vision loss. 3,6,7 Ocriplasmin is a recombinant truncated form of human plasmin indicated for treatment of symptomatic VMA, 8,9 which acts by hydrolyzing the protein matrix involved in the tractional forces at the macular region.…”