PDF
ePub
Citation
Print
Abstract
Purpose
To evaluate the efficacy and complication of autologous plasmin (AP) injected before vitrectomy for rhegmatogenous retinal detachment (RRD).
Methods
Intravitreal AP injection (0.2 ml) was performed on the eyes without posterior vitreous detachment (PVD) 20 minutes before the vitrectomy for RRD. The extent of PVD was evaluated intraoperatively. Surgical PVD induction was performed and the ease of the procedure was graded. The extent of PVD, ease of PVD induction, and complications (including incidence of iatrogenic retinal break) were compared to those of the control eyes. In order to evaluate complications and measure activated partial thromboplastin time, a microbial culture of injected AP was performed and the rate of postoperative intraocular hemorrhage was investigated. Change in visual acuity and the rate of retinal reattachment were compared in order to evaluate the long-term surgical outcome.
Results
The extent of PVD was greater in the AP group than in the control group, and vitreal separation was facilitated by intravitreal AP injection. However, ease of PVD induction and frequency of iatrogenic retinal break found were not significantly different between cases and controls. Neither postoperative intraocular hemorrhage nor systemic coagulation abnormality occurred. Postoperative endophthalmitis and positive microbial culture of the AP solution were also not reported. There was no significant difference in the change in visual acuity and the rate of retinal reattachment between the two groups.
References
1. Uemura A, Nakamura M, Kachi S, et al. Effect of plasmin on laminin and fibronectin during plasmin-assisted vitrectomy. Arch Ophthalmol. 2005; 123:209–13.
2. Rizzo S, Pellegrini G, Benocci F, et al. Autologous plasmin for pharmacologic vitreolysis prepared 1 hour before surgery. Retina. 2006; 26:792–6.
3. Kim MS, Moon SW, Kim ES, et al. Comparison of vitreolytic effect in rabbit eyes: plasmin, hyaluronidase, and their mixtures. J Korean Ophthalmol Soc. 2009; 50:911–8.
4. Gandorfer A, Priglinger S, Schebitz K, et al. Vitreoretinal morphology of plasmin-treated human eyes. Am J Ophthalmol. 2002; 133:156–9.
5. Li X, Shi X, Fan J. Posterior vitreous detachment with plasmin in the isolated human eye. Graefes Arch Clin Exp Ophthalmol. 2002; 240:56–62.
6. Benz MS, Packo KH, Gonzalez V, et al. A placebo-controlled trial of microplasmin intravitreous injection to facilitate posterior vitreous detachment before vitrectomy. Ophthalmology. 2010; 117:791–7.
7. Asami T, Terasaki H, Kachi S, et al. Ultrastructure of internal limiting membrane removed during plasmin-assisted vitrectomy from eyes with diabetic macular edema. Ophthalmology. 2004; 111:231–7.
8. Gandorfer A. Experimental evaluation of microplasmin – an alternative to vital dyes. Dev Ophthalmol. 2008; 42:153–9.
9. Gandorfer A, Rohleder M, Sethi C, et al. Posterior vitreous detachment induced by microplasmin. Invest Ophthalmol Vis Sci. 2004; 45:641–7.
10. Kim NJ, Yu HG, Yu YS, Chung H. Long-term effect of plasmin on the vitreolysis in rabbit eyes. Korean J Ophthalmol. 2004; 18:35–40.
11. Wang F, Wang Z, Sun X, et al. Safety and efficacy of dispase and plasmin in pharmacologic vitreolysis. Invest Ophthalmol Vis Sci. 2004; 45:3286–90.
12. Nagai N, Demarsin E, Van Hoef B, et al. Recombinant human microplasmin: production and potential therapeutic properties. J Thromb Haemost. 2003; 1:307–13.
13. de Smet MD, Gandorfer A, Stalmans P, et al. Microplasmin intravitreal administration in patients with vitreomacular traction scheduled for vitrectomy: the MIVI I trial. Ophthalmology. 2009; 116:1349–55. 1355 e1–2.
14. Hirata A, Takano A, Inomata Y, et al. Plasmin-assisted vitrectomy for management of proliferative membrane in proliferative diabetic retinopathy: a pilot study. Retina. 2007; 27:1074–8.
15. Margherio AR, Margherio RR, Hartzer M, et al. Plasmin en-zyme-assisted vitrectomy in traumatic pediatric macular holes. Ophthalmology. 1998; 105:1617–20.
16. Trese MT, Williams GA, Hartzer MK. A new approach to stage 3 macular holes. Ophthalmology. 2000; 107:1607–11.
17. Tsukahara Y, Honda S, Imai H, et al. Autologous plasmin-assisted vitrectomy for stage 5 retinopathy of prematurity: a preliminary trial. Am J Ophthalmol. 2007; 144:139–41.
18. Williams JG, Trese MT, Williams GA, Hartzer MK. Autologous plasmin enzyme in the surgical management of diabetic retinopathy. Ophthalmology. 2001; 108:1902–5. discussion 1095–6.
19. Wu WC, Drenser KA, Capone A, et al. Plasmin enzyme-assisted vitreoretinal surgery in congenital X-linked retinoschisis: surgical techniques based on a new classification system. Retina. 2007; 27:1079–85.
20. Wu WC, Drenser KA, Lai M, et al. Plasmin enzyme-assisted vitrectomy for primary and reoperated eyes with stage 5 retinopathy of prematurity. Retina. 2008; 28:S75–80.
21. Stalmans P, Delaey C, de Smet MD, et al. Intravitreal injection of microplasmin for treatment of vitreomacular adhesion: results of a prospective, randomized, sham-controlled phase II trial (the MIVI-IIT trial). Retina. 2010; 30:1122–7.
22. Machemer R, Aaberg TM, Freeman HM, et al. An updated classification of retinal detachment with proliferative vitreoretinopathy. Am J Ophthalmol. 1991; 112:159–65.
23. Schulze-Bonsel K, Feltgen N, Burau H, et al. Visual acuities “hand motion” and “counting fingers” can be quantified with the freiburg visual acuity test. Invest Ophthalmol Vis Sci. 2006; 47:1236–40.
24. Sebag J. Age-related differences in the human vitreoretinal interface. Arch Ophthalmol. 1991; 109:966–71.
25. Wu WC, Drenser KA, Trese MT, et al. Pediatric traumatic macular hole: results of autologous plasmin enzyme-assisted vitrectomy. Am J Ophthalmol. 2007; 144:668–72.
Figure 1.
Extent of posterior vitreous detachment. 0: none; 1: partial; 2: to equator: 3: to vitreal base.
Figure 2.
Easiness of posterior vitreous detachment (PVD) induction. 0: with microforceps or pick; 1: by high suction on disc; 2: by low suction on disc; 3: on high suction core vitrectomy; 4: on low suction core vitrectomy; 5: complete PVD with Weiss ring. AP group = autologous plasmin group.
Figure 3.
Easiness of vitreal separation. 0: present on vitrectomy; 1: very easy; 2: easy; 3: moderately difficult; 4: difficult; 5: failure. AP group = autologous plasmin group.
Table 1.
Grading scales of evaluation parameters
Table 2.
Patient demographics
| AP group | Control group | Total | Significance* | |
|---|---|---|---|---|
| Number | 7 | 7 | 14 | |
| Age (mean ± SD, yr) | 24.0 ± 13.9 | 25.7 ± 17.2 | 24.9 ± 15.1 | 0.605 |
| Sex (M:F) | 4:3 | 5:2 | 0.591 | |
| PVR grade (A:B:CP:CA)†22 | 1:2:2:2 | 1:1:5:0 |
† PVR grade A = vitreous haze, vitreous pigment clumps, pigment clusters on inferior retina; B = wrinkling of inner retinal surface, retinal stiffness, vessel tortuosity, rolled and irregular edge of retinal break, decreased mobility of vitreous; CP = posterior to equator, focal, diffuse, or circumferential full-thickness folds, subretinal strands; CA = anterior to equator, focal, diffuse, or circumferential full-thickness folds, subretinal strands, anterior displacement, condensed vitreous strands.
Table 3.
Effectiveness and complications of AP injection before vitrectomy
| AP group | Control group | Significance* | |
|---|---|---|---|
| PVD extent (mean ± SD) | 0.86 ± 0.90 | 0 | 0.025 |
| Easiness of PVD induction (mean ± SD) | 2.00 ± 2.00 | 1.50 ± 1.13 | 0.744 |
| Easiness of vitreal separation (mean ± SD) | 1.86 ± 1.22 | 3.29 ± 0.76 | 0.034 |
| Retinal tear (n) | 1 | 2 | 0.530 |
| Intraocular hemorrhage (n) | 0 | 0 | |
| Coagulation abnormality (n) | 0 | 0 |
XML Download