[Enzymatically induced posterior vitreous detachment in proliferative diabetic vitreoretinopathy].
BACKGROUND
Complete detachment of the posterior vitreous cortex is an important aim in the treatment of proliferative diabetic vitreoretinopathy (PDVR). Today a posterior vitreous detachment (PVD) can only be achieved during vitrectomy. A randomized pilot study was started to evaluate wether intravitreally injected TPA is sufficient to induce a PVD in diabetic eyes.


METHODS
Eight weeks prior to vitrectomy because of proliferative diabetic vitreoretinopathy (non-clearing haemorrhage, fibrovascular proliferations) 20 eyes which had an attached vitreous received a cryopexy of the peripheral retina. In 11 eyes that had been selected at random 10 micrograms of recombinant tissue plasminogen activator were injected midvitreally 24 hrs later. A newly formed PVD was assessed by means of biomicroscopy or ultrasound.


RESULTS
A newly formed partial (n = 3) or complete (n = 7) PVD was found in 10 of 11 TPA-treated eyes versus one partial detached vitreous in the control group. In 3 younger patients PVD developed exclusively after TPA-injection. We did not observe severe changes of the ERG, decrease of visual acuity, severe new vitreous haemorrhages or opacities of the lens. In 3 eyes (2 eyes of the control group) a circumscribed retinal detachment developed during the follow-up period.


CONCLUSIONS
The described technique can be used in diabetics without severe side effects. It facilitates the removal of the vitreous cortex and may be a valuable adjunct to the surgical management of PDVR. Unlike other proteases TPA is available for clinical use through recombinant DNA technology which allows standardized enzymatic activities, steril and non-infectious conditions.
Hesse
L
L
Augenklinik der Philipps-Universität, Marburg. hesse@mailer.uni-marburg.de
Kroll
P
P
D000328:Adult; D000368:Aged; D003930:Diabetic Retinopathy / Q000000981:diagnostic imaging / Q000378:metabolism / Q000628:therapy*; D006801:Humans; D007267:Injections; D008875:Middle Aged; D010865:Pilot Projects; D011897:Random Allocation; D011994:Recombinant Proteins / Q000009:adverse effects / Q000378:metabolism; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000378:metabolism; D014463:Ultrasonography; D018630:Vitreoretinopathy, Proliferative / Q000000981:diagnostic imaging / Q000378:metabolism / Q000628:therapy*; D014822:Vitreous Body / Q000000981:diagnostic imaging / Q000187:drug effects / Q000378:metabolism; D020255:Vitreous Detachment / Q000000981:diagnostic imaging / Q000201:enzymology*
D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator