Research advances of pharmacological vitreolysis

With the development of OCT technology in recent years, vitreoretinal interface diseases have become the focus of attention and research gradually. Incomplete posterior vitreous detachment (PVD) can lead to vitreomacular adhesion (VMA) and a series of related complications. Compared with traditional vitrectomy, enzyme-assisted or alternative therapy is safer and more convenient. This article reviewed the experimental and clinical studies of different enzymes in inducing PVD and treating VMA-related diseases. The first-generation enzymatic agents, such as hyaluronidase, chondroitinase, dispase, plasmin and tissue plasminogen activator (TPA), are limited in clinical research and application because of their effectiveness and safety. As the second-generation enzymatic agents, the efficacy of intravitreal ocriplasmin for both vitreomacular traction (VMT) syndrome and full-thickness macular hole (FTMH) is better than MIVI-TRUST(microplasmin for intravitreous injection-traction release without surgical treatment) trial. At present, ocriplasmin is the first choice for the treatment of VMA and related diseases. The common complications of intravitreal ocriplasmin include transient blurred vision, photopsia, dyschromatopsia, conjunctival hyperemias, elevated intraocular pressure, etc. Patients with macular degeneration should be used prudently. (Int Rev Ophthalmol, 2019, 43: 100-104) Key words: pharmacological vitreolysis; posterior vitreous detachment; vitreomacular adhesion