title: [Enzymatic vitrectomy by intravitreal autologous plasmin injection as initial treatment for macular epiretinal membranes and vitreomacular traction syndrome].
abstract: OBJECTIVE
  To determine the effectiveness of intravitreal plasmin injection in the treatment of macular epiretinal membranes (MEM) and vitreomacular traction syndrome (VMTS) without associated pars plana vitrectomy.
  
  
  METHODS
  
  
  
  METHODS
  Interventional, prospective, case series pilot study.
  
  
  METHODS
  Seven patients were enrolled in the study, 4 with MEM and 3 with VMTS.
  
  
  METHODS
  0.2 ml of autologous plasmin intravitreally injected under topical anesthesia was administered to all patients. The plasmin was obtained by a simplified method with urokinase.
  
  
  METHODS
  Degree of detachment of the MEM and the VMTS measured by optical coherence tomography (OCT), and the best corrected visual acuity (Snellen scale) before and one month after the plasmin injection.
  
  
  RESULTS
  The follow-up period was completed by all the patients. The MEM remained attached to the retina in all cases, as measured either by biomicroscopy or OCT. The VMTS was completely detached from the foveal area in all cases, with the disappearance of secondary tractional retinal folds and recovery of the normal macular anatomic architecture as measured by OCT. Visual acuity was not modified in any of the MEM patients, and improved in all VMTS patients. No adverse effects were observed.
  
  
  CONCLUSIONS
  In our case series, intravitreally injected autologous plasmin was not effective in the treatment of MEM, but resolved VMTS successfully, improving the visual acuity and releasing the retinal traction without the need for associated pars plana vitrectomy. Larger studies to confirm the efficacy of this technique and the possibility of success after repeated injections are warranted.
authors.affiliation: Departamento de Oftalmología, Hospital La Fe de Valencia, Valencia, España. manuel.diaz@uv.es
authors.forename: M
authors.initials: M
authors.lastname: Díaz-Llopis
authors.forename: P
authors.initials: P
authors.lastname: Udaondo
authors.forename: E
authors.initials: E
authors.lastname: Cervera
authors.forename: S
authors.initials: S
authors.lastname: García-Delpech
authors.forename: D
authors.initials: D
authors.lastname: Salom
authors.forename: A
authors.initials: A
authors.lastname: Quijada
authors.forename: F J
authors.initials: FJ
authors.lastname: Romero
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019773:Epiretinal Membrane / Q000601:surgery*; D005260:Female; D005341:Fibrinolysin / Q000008:administration & dosage / Q000302:isolation & purification / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012164:Retinal Diseases / Q000628:therapy*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*; D014822:Vitreous Body / Q000187:drug effects*
chemical_list: D005341:Fibrinolysin