title: Pharmacologic vitreolysis with ocriplasmin: rationale for use and therapeutic potential in vitreo-retinal disorders.
abstract: With increased knowledge about the origins and pathophysiology of vitreo-retinal disorders—and, in particular, the central role of anomalous posterior vitreous detachment in vitreo-maculopathies—a paradigm shift from surgery to pharmacotherapy is taking place with the development of pharmacologic vitreolysis. The first approved agent for pharmacologic vitreolysis therapy is ocriplasmin, a truncated form of the nonspecific serine protease plasmin. Twelve studies comprise the current ocriplasmin clinical trial program, demonstrating the efficacy and safety of a single intravitreal injection of ocriplasmin for the treatment of patients with symptomatic vitreo-macular adhesion or vitreo-macular traction, including patients with macular holes. Although post-approval implementation of ocriplamsin in clinical practice has shown success rates of up to 78%, there have been recent case reports of acute, transient visual dysfunction. There are thus new initiatives to further refine clinical indications for case selection and to identify possible untoward effects. Although more studies are warranted, it appears that ocriplasmin offers a good alternative to surgery. The future lies in pharmacologic vitreolysis, and the future of pharmacologic vitreolysis lies in prevention. Thus, long-term studies are needed to define a role for pharmacologic vitreolysis, in particular with ocriplasmin, in the prevention of progressive diabetic retinopathy and age-related macular degeneration.
authors: VMR Institute for Vitreous Macula Retina, 7677 Center Avenue, Suite 400, Huntington Beach, CA, 92647, USA, mkhoshne@uci.edu.
authors: Matin
authors: M
authors: Khoshnevis
authors: J
authors: J
authors: Sebag
mesh_terms: D000818:Animals; D003930:Diabetic Retinopathy / Q000188:drug therapy*; D005341:Fibrinolysin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007258:Informed Consent; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy*; D018579:Patient Selection; D010446:Peptide Fragments / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D014822:Vitreous Body / Q000187:drug effects*; D020255:Vitreous Detachment / Q000188:drug therapy*
chemical_list: D010446:Peptide Fragments; C054561:microplasmin; D005341:Fibrinolysin