Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Ophthalmol. Aug 12, 2015; 5(3): 99-105
Published online Aug 12, 2015. doi: 10.5318/wjo.v5.i3.99
Pharmacologic vitreolysis: New strategy for treatment of anomalous vitreo-macular adhesion
Desislava N Koleva-Georgieva
Desislava N Koleva-Georgieva, Clinic of Ophthalmology, “St. George” Hospital, 4001 Plovdiv, Bulgaria
Desislava N Koleva-Georgieva, Department of Ophthalmology, Faculty of Medicine, Medical University of Plovdiv, 4001 Plovdiv, Bulgaria
Author contributions: Koleva-Georgieva DN solely contributed to this paper.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Desislava N Koleva-Georgieva, MD, PhD, FEBO, Assistant Professor, Department of Ophthalmology, Faculty of Medicine, Medical University of Plovdiv, Pestersko shose 66, 4001 Plovdiv, Bulgaria. dr_desikoleva@yahoo.com
Telephone: +359-32-602780 Fax: +359-32-602481
Received: January 29, 2015
Peer-review started: January 29, 2015
First decision: March 6, 2015
Revised: April 30, 2015
Accepted: July 16, 2015
Article in press: July 17, 2015
Published online: August 12, 2015
Abstract

Persistent anomalous vitreo-macular adhesion (VMA) is a well-known factor, associated with a variety of sight threatening diseases - including macular hole, vitreo-macular traction syndrome, cystoid and diabetic macular edema, exudative age- related macular degeneration, myopic traction maculopathy and others. With the advent of optical coherence tomography our understanding of these pathologies and the ability of their early diagnosis has gone much far in the past two decades. The release of macular traction has been of exclusive surgical capability. Notwithstanding good results, vitrectomy is hampered by the inability of complete vitreo-retinal separation (i.e., smooth, bare internal limiting membrane), compulsory postoperative positioning in macular hole cases, surgical complications, and high costs. With aim to offer less invasive and safe treatment modality for anomalous VMA, investigators have made enormous progress in the past decade. Leading among the studied nonsurgical measures is the intravitreal application of pharmacologic agents for the induction of vitreo-retinal separation and vitreous liquefaction, a method termed pharmacologic vitreolysis. Several vitreolytic agents have been studied to date, the most potent among them proved to be plasmin. Recently, ocriplasmin (formerly known as microplasmin) - a more stable than plasmin recombinant product, proved to be safe and efficient in releasing VMA in large studies, and consequently received FDA approval. It’s role in clinical practice is now in the process of being determined. This paper aims to review and summarize the current knowledge and status of investigation on this new approach for the treatment of VMA.

Keywords: Pharmacologic vitreolysis, Vitreo-macular adhesion, Posterior vitreous detachment, Macular hole, Microplasmin

Core tip: Persistent anomalous vitreo-macular adhesion (VMA) is a well-known factor, associated with a variety of sight threatening diseases (macular hole, vitreo-macular traction syndrome, macular edema, exudative age-related macular degeneration). The release of traction has been of exclusive surgical capability. Notwithstanding good results, vitrectomy is hampered by the inability of complete vitreo-retinal separation and surgical complications. With aim to overcome limitations of surgery, investigators have made enormous progress with the advent of pharmacologic vitreolysis - a method for releasing VMA by intravitreal drug delivery. This paper aims to summarize the current knowledge and status of investigation on this new treatment approach.