Intravitreal ocriplasmin: A breakthrough in the treatment of vitreomacular traction?

Vitreoretinal interface pathologies, such as vitreomacular traction syndrome, epiretinal membranes and macular holes are sight-threatening conditions and one of the important causes of vision defects and vision loss. To this date, vigilance with observation of how the vitreomacular traction resolves, or vitreoretinal surgery in more severe cases, were the only treatment options. Recent rapid progress in ophthalmology, especially in diagnostic and visualization techniques, provided better insight into the mechanisms taking place on the vitreoretinal surface, which enabled a more accurate selection of treatment options. Development of ophthalmic pharmacological procedures, such as treatment of vitreomacular traction syndrome with ocriplasmin, constitutes an innovative breakthrough in ophthalmology. The enzyme is a genetically engineered form of human plasmin, a component of blood coagulation cascade that has been envisioned for human therapy since 1950s. It has never been used for vitreolysis in ophthalmology before. The aim of this review is to analyze and compare therapeutic options for symptomatic vitreomacular adhesion and vitreoretinal traction, with particular emphasis on microplasmin. We reviewed the results of recent studies comparing ocriplasmin to other widespread treatment options, such as pars plana vitrectomy.

Acute retinal necrosis--a case report.

Acute retinal necrosis (ARN) is a rare but very severe form of retinitis. In contrast to progressive outer retinal necrosis acute retinal necrosis typically affects immunocompetent individuals. Herpes Simplex and Varicella-zoster viruses play the main role in the development of the disease. We report a case study of a healthy, young male who presented to the ophthalmologist with unilateral visual acuity decrease and eye irritation. The acute retinal necrosis was diagnosed and a therapy was started including both systemic and local anti-viral agents, as well as an oral anticoagulant. Additional systemic steroid therapy was introduced a week later. The regression of retinal inflammatory changes and the improvement of visual acuity were observed. The polymerase chain reaction assay for the presence of viral DNA in serum was negative. The IgM antibody assay for potential causal pathogens was negative, but the level of Varicella-zoster virus IgG antibodies was markedly elevated. During the follow-up, the patient developed retinal detachment and pars plana vitrectomy with silicone oil endotamponade was performed. Although the surgery resulted in the successful retinal reattachment, the final visual acuity remained decreased. Six months after the surgery, the eye was free of the intraocular inflammation and the visual acuity slightly improved.