Pharmacologic Vitreolysis: New Perspectives, Future Directions
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Ocriplasmin is currently the only approved pharmacologic agent for the release of vitreo-macular traction. Its success rate in releasing vitreo-macular traction under optimal conditions is about 40 %. Traction is present in a number of processes leading to macular disease, which suggests that its prophylactic release might have significant clinical relevance. Release of traction or vitreous adhesion in conditions such as macular edema from diabetes or retinal vein occlusion, vascular proliferation, or retinal degeneration or neovascularization can be considered under appropriate circumstances. To this end, the biology of the particular disease process must be considered. Partial release of the posterior hyaloid in pre-proliferative diabetic retinopathy may be associated with an increase risk of proliferation, while in macular edema, early intervention may be required for success.
A challenge will be the development of a treatment regimen that enhances the rate with which complete PVD is achieved either with a single or multiple injections or by combination with other pharmacologic agents. It will also be important to develop means of improving the visualization of the interface between the retina and vitreous. Specific scanning techniques and algorithms currently being developed for the OCT and new ultrasonographic probes are likely to facilitate such visualization and help in the diagnostic and therapeutic management of patients with diseases at the vitreoretinal interface.
KeywordsMacular Edema Macular Hole Proliferative Diabetic Retinopathy Retinal Vein Occlusion Posterior Vitreous Detachment
- Gad El Kareem A, Zwinderman AH, Mateo-Montoya A, et al (2013) The vitreous and its retinal interface in ocular health and disease. Ophthalmologica (in press)Google Scholar