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VI.A. Pharmacologic Vitreolysis

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Vitreous

Abstract

Vitreous constitutes about 80 % of the volume of the human eye. It is an extended extracellular matrix that is composed of collagen, hyaluronan, and other extracellular matrix molecules but is 98 % water. In both health as well as disease, the molecular composition and organization of vitreous dictates the structure and function of the vitreous body as well as the status of the vitreoretinal interface. During aging, there is reorganization of vitreous macromolecules resulting in gel liquefaction and structural changes that destabilize the vitreous body. Molecular changes at the vitreoretinal interface, whose components are the retinal inner limiting membrane (ILM), the posterior vitreous cortex, and the intervening extracellular matrix (ECM), usually weaken vitreoretinal adhesion and allow the collapsing destabilized vitreous to separate from the retina, a condition called posterior vitreous detachment (PVD) [see chapter II.C. Vitreous aging and posterior vitreous detachment]. When there is insufficient weakening of vitreoretinal adherence, anomalous PVD occurs with various pathologic effects on both vitreous and retina [see chapter III.B. Anomalous PVD and vitreoschisis]. To date, these pathologies have been treated with surgery.

J. Sebag is a past or present consultant to Advanced Corneal Systems/ISTA Pharmaceuticals, Storz/B & L, ThromboGenics, ALCON

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References

  1. Bishop P, McLeod D, Reardon A. Effects of hyaluronan lyase, hyaluronidase, and chondroitin ABC lyase on mammalian vitreous gel. Invest Ophthalmol Vis Sci. 1999;40(10):2173–8.

    PubMed  CAS  Google Scholar 

  2. Brem RB, Robbins SG, Wilson DJ, O'Rourke LM, Mixon RN, Robertson JE, Planck SR, Rosenbaum JT. Immunolocalization of integrins in the human retina. Invest Ophthalmol Vis Sci. 1994;35(9):3466–74.

    PubMed  CAS  Google Scholar 

  3. Duker JS, Kaiser PK, Binder S, de Smet MD, Gaudric A, Reichel E, Sadda SR, Sebag J, Spaide RF, Stalmans P. The International Vitreomacular Traction Study (IVTS) group classification of vitreo-macular adhesion, traction, and macular hole. Ophthalmology. 2013;120(12):2611–9.

    Article  PubMed  Google Scholar 

  4. El-Ashry M, Hegde V, James P, Pagliarini S. Analysis of macular thickness in British population using optical coherence tomography (OCT) - an emphasis on interocular symmetry. Curr Eye Res. 2008;33:693–9.

    Article  PubMed  Google Scholar 

  5. Fink W, Sadun AA. 3D computer-automated threshold Amsler grid test. J Biomed Opt. 2004;9(1):149–53.

    Article  PubMed  Google Scholar 

  6. Gandorfer A. Enzymatic vitreous disruption. Eye (Lond). 2008;22(10):1273–7.

    Article  CAS  Google Scholar 

  7. Girish KS, Kemparaju K. The magic glue hyaluronan and its eraser hyaluronidase: a biological overview. Life Sci. 2007;80:1921–43.

    Article  PubMed  CAS  Google Scholar 

  8. Hikichi T, Kado M, Yoshida A. Intravitreal injection of hyaluronidase cannot induce posterior vitreous detachment in the rabbit. Retina. 2000;20(2):195–8.

    Article  PubMed  CAS  Google Scholar 

  9. Hikichi T, Yangiya N, Kado M, Akiba J, Yoshida A. Poetrior vitreous detachment induced by injection of plasmin and sulfur hexafluoride in the rabbit vitreous. Retina. 1999;19:55–8.

    Article  PubMed  CAS  Google Scholar 

  10. Hynes RO. Integrins: versatility, modulation, and signaling in cell adhesion. Cell. 1992;69(1):11–25.

    Article  PubMed  CAS  Google Scholar 

  11. Jivrajka RV, Kim JK, Fink W, Sadun AA, Sebag J. Quantitative analysis of central visual field defects in macular edema using three-dimensional computer-automated threshold Amsler grid testing. Graefes Arch Clin Exp Ophthalmol. 2009;247:165–70.

    Article  PubMed  Google Scholar 

  12. Kang SW, Hyung S-M, Choi MY, Lee J. Induction of vitreolysis and vitreous detachment with hyaluronidase and perfluoropropane gas. Korean J Ophthalmol. 1995;9:69–78.

    Article  PubMed  CAS  Google Scholar 

  13. Karageozian HL. Determine the safety and efficacy of Vitreosolve® administered intravitreally to induce a complete posterior vitreous detachment (PVD) in non proliferative diabetic retinopathy human subjects. Invest Ophthalmol Vis Sci (ARVO). 2005;46:5453.

    Google Scholar 

  14. Nguyen J, Yee KM, Wa C, Sadun A. Macular pucker lowers contrast sensitivity which improves after surgery. Invest Ophthalmol Vis Sci. 2014 (ARVO).

    Google Scholar 

  15. Oliveira LB, Tatebayashi M, Mahmoud TH, Blackmon SM, Wong F, McCuen 2nd BW. Dispase facilitates posterior vitreous detachment during vitrectomy in young pigs. Retina. 2001;21(4):324–31.

    Article  PubMed  CAS  Google Scholar 

  16. Oliveira LB, Meyer CH, Kumar J, Tatebayashi M, Toth CA, Wong F, Epstein DL, McCuen 2nd BW. RGD peptide-assisted vitrectomy to facilitate induction of a posterior vitreous detachment: a new principle in pharmacological vitreolysis. Curr Eye Res. 2002;25(6):333–40.

    Article  PubMed  Google Scholar 

  17. Pirie A. Effect of hyaluronidase injection on vitreous humor of rabbit. Br J Ophathalmol. 1949;33:678–84.

    Article  CAS  Google Scholar 

  18. Robert L, Robert AM, Renard G. Biological effects of hyaluronan in connective tissues, eye, skin, venous wall. Role in aging. Pathol Biol (Paris). 2010;58:187–98.

    Article  CAS  Google Scholar 

  19. Robison CD, Jivrajka RV, Bababeygy SR, Fink W, Sadun AA, Sebag J. Distinguishing wet from dry age-related macular degeneration using three-dimensional computer-automated threshold Amsler grid testing. Br J Ophthalmol. 2011;95(10):1419–23.

    Article  PubMed  Google Scholar 

  20. Ruoslahti E, Pierschbacher MD. New perspectives in cell adhesion: RGD and integrins. Science. 1987;238(4826):491–7.

    Article  PubMed  CAS  Google Scholar 

  21. Russell SR. What we know (and don't know) about the vitreoretinal interface. Retina. 2012;32(Suppl):S181–6.

    Article  PubMed  Google Scholar 

  22. Sebag J. Abnormalities of human vitreous structure in diabetes. Graefes Arch Clin Exp Ophthalmol. 1993;231:257–60.

    Article  PubMed  CAS  Google Scholar 

  23. Sebag J. Pharmacologic vitreolysis. Retina. 1998;18(1):1–3.

    Article  PubMed  CAS  Google Scholar 

  24. Sebag J. Is pharmacologic vitreolysis brewing? Retina. 2002;22(1):1–3.

    Article  PubMed  CAS  Google Scholar 

  25. Sebag J. Pharmacologic vitreolysis-premise and promise of the first decade. Retina. 2009;29(7):871–4.

    Article  PubMed  CAS  Google Scholar 

  26. Sebag J. The emerging role of pharmacologic vitreolysis. Retin Physician. 2010;7(2):52–6.

    Google Scholar 

  27. Sebag J, Buckingham B, Charles MA, Reiser K. Biochemical abnormalities in vitreous of humans with proliferative diabetic retinopathy. Arch Ophthalmol. 1992;110:1472–9.

    Article  PubMed  CAS  Google Scholar 

  28. Sebag J, Nie S, Reiser KA, Charles MA, Yu NT. Raman spectroscopy of human vitreous in proliferative diabetic retinopathy. Invest Ophthalmol Vis Sci. 1994;35:2976–80.

    PubMed  CAS  Google Scholar 

  29. Sebag J, Wang M, Nguyen D, Sadun AA. Vitreo-papillary adhesion in macular diseases. Trans Am Ophthalmol Soc. 2009;107:35–46.

    PubMed  CAS  PubMed Central  Google Scholar 

  30. Sumi H, Hamada H, Tsushima H, Mihara H, Muraki H. A novel fibrinolytic enzyme (nattokinase) in the vegetable cheese Natto; a typical and popular soybean food in the Japanese diet. Experientia. 1987;43(10):1110–1.

    Article  PubMed  CAS  Google Scholar 

  31. Takano A, Hirata A, Ogasawara K, Sagara N, Inomata Y, Takahiro K, Tanihara H. Posterior vitreous detachment induced by nattokinase (Subtilisin NAT): a novel enzyme for pharmacologic vitreolysis. Invest Ophthalmol Vis Sci. 2006;47(5):2075–9.

    Article  PubMed  Google Scholar 

  32. Tozer KR, Fink W, Sadun AA, Sebag J. Prospective three-dimensional analysis of structure and function in vitreo-macular adhesion cured by pharmacologic vitreolysis. Retin Cases Brief Rep. 2013;7:57–61.

    Article  PubMed  Google Scholar 

  33. Turner RB, Liu L, Sazonova IY, Reed GL. Structural elements that govern the substrate specificity of the clot-dissolving enzyme plasmin. J Biol Chem. 2002;277:33068–74.

    Article  PubMed  CAS  Google Scholar 

  34. Wall M, Sadun AA. Threshold amsler grid testing: cross-polarizing lenses enhance yield. Arch Ophthalmol. 1986;104:520–3.

    Article  PubMed  CAS  Google Scholar 

  35. Wang MY, Nguyen D, Hindoyan N, Sadun AA, Sebag J. Vitreo-papillary adhesion in macular hole and macular pucker. Retina. 2009;29:644–50.

    Article  PubMed  Google Scholar 

  36. Wang ZL, Zhang X, Xu X, Sun XD, Wang F. PVD following plasmin but not hyaluronidase: implications for combination pharmacologic vitreolysis therapy. Retina. 2005;25(1):38–43.

    Article  PubMed  CAS  Google Scholar 

  37. Wu HL, Shi GY, Bender ML. Preparation and purification of microplasmin. Proc Natl Acad Sci U S A. 1987;84:8292–5.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  38. Yatagai C, Maruyama M, Kawahara T, Sumi H. Nattokinase-promoted tissue plasminogen activator release from human cells. Pathophysiol Haemost Thromb. 2008;36(5):227–32.

    Google Scholar 

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Correspondence to J. Sebag MD, FACS, FRCOphth, FARVO .

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Sebag, J. (2014). VI.A. Pharmacologic Vitreolysis. In: Sebag, J. (eds) Vitreous. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1086-1_47

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  • DOI: https://doi.org/10.1007/978-1-4939-1086-1_47

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