Plasmin Enzyme-Assisted Vitrectomy in Pediatric Patients with Vitreoretinal Diseases

Abstract

Purpose: To evaluate the efficacy and safety of using plasmin-assisted vitrectomy in pediatric patients with vitreoretinal diseases. Methods: We prospectively recruited children aged 16 years or younger who presented with vitreoretinopathies and underwent plasmin-assisted vitrectomy between 2012 and 2013. The main outcome measure was the induction of posterior vitreous detachment (PVD) using a suction power of 200 mm Hg or less during surgery. Results: Eleven eyes of 11 patients (mean age: 3.7 years; average follow-up duration: 14.1 months) were included. Of these 11 patients, there were 3 (27%) cases of stage 5 retinopathy of prematurity, 2 (18%) cases of persistent fetal vasculature, 2 (18%) cases of rhegmatogenous retinal detachment, 2 (18%) cases of idiopathic epiretinal membrane, 1 (9%) case of traumatic macular pucker, and 1 (9%) case of traumatic vitreous hemorrhage (9%). PVD was achieved in all cases (100%) during surgery using low suction after plasmin treatment (mean: 150 ± 39 mm Hg; range: 100-200). Overall, anatomical success was achieved in 8 eyes (73%). Visual acuity improved in all 5 (100%) patients for whom vision could be measured at 6 months after the operation. Cataracts were found in 4 eyes (36%), and a rise in transient intraocular pressure was observed in 1 eye (9%). Conclusions: Plasmin-assisted vitrectomy offers an effective and less traumatic intervention for a variety of pediatric vitreoretinal diseases.

Intravitreal recombinant tPA before vitrectomy for diabetic tractional retinal detachment: A randomized controlled trial

“…24 Intravitreal autologous plasmin has been used successfully as an adjunct in surgery for pediatric vitreoretinopathies including retinopathy of prematurity, persistent fetal vasculature and retinal detachments by facilitating posterior vitreous detachment induction and more complete vitreous removal. [25][26][27] However, its widespread use is limited by difficulty in plasmin extraction and activation, concerns surrounding sterility and its highly unstable structure. 28 rt-PA has the advantage of being commercially available and has been shown to be safe.…”

Management of retinopathy of prematurity: an updated review

“…73 Otherwise, currently studied novel techniques such as plasmin-assisted vitrectomy show promising results, awaiting future evidence and recommendations. 74…”