Intrasurgical plasmin enzyme in diabetic macular edema.
OBJECTIVE
To evaluate in a prospective study the efficacy of intrasurgical autologous plasmin enzyme (APE) in producing posterior vitreous detachment.


METHODS
Consecutive, interventional case series.


METHODS
A group of 12 eyes of 11 patients with diabetic macular edema secondary to posterior vitreous cortex contraction was considered. A quantity of 0.1- to 0.2-ml containing 0.8 to 1.2 IU of APE prepared by our Coagulation Service was injected into the vitreous body 25 minutes before surgery. The efficacy of the APE was subjectively evaluated. A control group of 10 eyes with the same clinical characteristics underwent the same surgery without APE injection. Complete eye examinations, including optical coherence tomography, were performed on all patients before surgery and during the 1-year follow-up period.


RESULTS
During surgery in the APE-treated group, the posterior vitreous cortex was judged adherent in three cases, partially detached in six cases, and totally detached in three cases. In two cases a complete collapse of the vitreous body was observed. During surgery in the non-APE-treated group, the posterior vitreous cortex was judged still adherent in nine of 10 eyes and partially detached in 1 eye. Comparing the postoperative results between the APE-treated group and the non-APE-treated group, we found no significant differences in final postoperative retinal thickness (P = .2552), whereas we found a significant difference in final visual acuity (P = .0121).


CONCLUSIONS
Autologous plasmin enzyme was useful in inducing a pharmacologic posterior vitreous detachment and in facilitating surgery. It did not seem to interfere with the final retinal thickness, and it ameliorates the final visual acuity.
Department of Ophthalmology and Visual Sciences, Vita-Salute San Raffaele University, Milan, Italy. azzolini.claudio@hsr.it <azzolini.claudio@hsr.it>
Claudio
C
Azzolini
Armando
A
D'Angelo
Gisella
G
Maestranzi
Marco
M
Codenotti
Patrizia
P
Della Valle
Matteo
M
Prati
Rosario
R
Brancato
D000368:Aged; D003930:Diabetic Retinopathy / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D005128:Eye Diseases / Q000150:complications; D005260:Female; D005341:Fibrinolysin / Q000008:administration & dosage / Q000627:therapeutic use*; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D007432:Intraoperative Period; D008269:Macular Edema / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D014821:Vitrectomy; D014822:Vitreous Body / Q000187:drug effects* / Q000473:pathology; D020255:Vitreous Detachment / Q000139:chemically induced
D005343:Fibrinolytic Agents; D005341:Fibrinolysin