title: Vitreomacular traction syndrome: a comparison of treatment with intravitreal plasmin enzyme vs spontaneous vitreous separation without treatment.
abstract: OBJECTIVE
  To evaluate the effects of intravitreal autologous plasmin enzyme (APE) in patients with focal vitreomacular traction (VMT).
  
  
  METHODS
  APE was obtained by incubation of patient-derived purified plasminogen with streptokinase, and intravitreally injected 5-12 days later. Twenty-four hours after injection, in case of incomplete VMT release, a pars plana vitrectomy was performed. The hyaloid internal limiting membrane adherence and removal of the posterior hyaloid were intraoperatively evaluated.
  
  
  RESULTS
  Thirteen patients were recruited. During preparation of APE, five patients had spontaneous release of VMT. Eight patients received APE injection (2 IU). In five patients, spontaneous resolution of VMT occurred before APE administration. Twenty-four hours after injection, persistence of VMT was detected in all the eight treated patients. Best-corrected visual acuity was 0.51±0.37 LogMAR at baseline, improving to 0.23±0.14 LogMAR at 6 months (P=0.002). Foveal thickness was 464±180 μm at baseline, reducing to 246±59 μm at 6 months (P<0.001). Hyaloid was intraoperatively judged 'partially detached' in seven cases and 'totally detached' in one case. Hyaloid peeling was evaluated 'easy' in six eyes and 'very easy' in two eyes.
  
  
  CONCLUSIONS
  In the current study, there was a large percentage of spontaneous resolution of VMT before an APE administration. A single intravitreal APE injection seems insufficient to induce a complete posterior vitreous detachment in these patients.
authors.affiliation: Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Codenotti
authors.forename: G
authors.initials: G
authors.lastname: Maestranzi
authors.forename: U
authors.initials: U
authors.lastname: De Benedetto
authors.forename: G
authors.initials: G
authors.lastname: Querques
authors.forename: P
authors.initials: P
authors.lastname: Della Valle
authors.forename: L
authors.initials: L
authors.lastname: Iuliano
authors.forename: G
authors.initials: G
authors.lastname: Fogliato
authors.forename: A
authors.initials: A
authors.lastname: D'Angelo
authors.forename: F
authors.initials: F
authors.lastname: Bandello
mesh_terms: D000368:Aged; D005260:Female; D005341:Fibrinolysin / Q000008:administration & dosage*; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012075:Remission, Spontaneous; D012163:Retinal Detachment / Q000188:drug therapy*; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods; D020255:Vitreous Detachment / Q000188:drug therapy*
chemical_list: D005343:Fibrinolytic Agents; D005341:Fibrinolysin