Article
Enzyme-assisted vitrectomy: demands and reality
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Published: | September 22, 2004 |
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Many enzymes have been used in ocular surgery, and in particular in vitreoretinal surgery. The common goal of such surgery is to achieve posterior vitreous detachment (PVD) or vitreous liquification (vitreolysis). Previous and current concepts are discussed in this lecture. Plasmin holds the promise to create a clean vitreoretinal surface by inducing complete PVD, as shown by several pre-clincal studies. In these reports, the ultrastructure of the retina was unchanged following application of the enzyme. Autologous plasmin is effectively administered before macular surgery without inducing untowards effects to the retina. In pre-clinical studies, Microplasmin (ThromboGenics Ltd., Dublin), a truncated molecule containing the catalytic domaine of human plasmin, has been shown to create complete PVD without changing the ultrastructure and antigenity of the retina. Clinical studies with Microplasmin and autologous plasmin are underway, and will be introduced in this lecture.