[Enzymatically induced posterior vitreous detachment in proliferative diabetic vitreoretinopathy].

Abstract:

BACKGROUND:Complete detachment of the posterior vitreous cortex is an important aim in the treatment of proliferative diabetic vitreoretinopathy (PDVR). Today a posterior vitreous detachment (PVD) can only be achieved during vitrectomy. A randomized pilot study was started to evaluate wether intravitreally injected TPA is sufficient to induce a PVD in diabetic eyes. PATIENTS AND METHODS:Eight weeks prior to vitrectomy because of proliferative diabetic vitreoretinopathy (non-clearing haemorrhage, fibrovascular proliferations) 20 eyes which had an attached vitreous received a cryopexy of the peripheral retina. In 11 eyes that had been selected at random 10 micrograms of recombinant tissue plasminogen activator were injected midvitreally 24 hrs later. A newly formed PVD was assessed by means of biomicroscopy or ultrasound. RESULTS:A newly formed partial (n = 3) or complete (n = 7) PVD was found in 10 of 11 TPA-treated eyes versus one partial detached vitreous in the control group. In 3 younger patients PVD developed exclusively after TPA-injection. We did not observe severe changes of the ERG, decrease of visual acuity, severe new vitreous haemorrhages or opacities of the lens. In 3 eyes (2 eyes of the control group) a circumscribed retinal detachment developed during the follow-up period. CONCLUSIONS:The described technique can be used in diabetics without severe side effects. It facilitates the removal of the vitreous cortex and may be a valuable adjunct to the surgical management of PDVR. Unlike other proteases TPA is available for clinical use through recombinant DNA technology which allows standardized enzymatic activities, steril and non-infectious conditions.

journal_name

Klin Monbl Augenheilkd

authors

Hesse L,Kroll P

doi

10.1055/s-2008-1034754

subject

Has Abstract

pub_date

1999-02-01 00:00:00

pages

84-9

issue

2

eissn

0023-2165

issn

1439-3999

journal_volume

214

pub_type

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