V.A.2. Vitreomaculopathy Surgery

Figueroa, Marta S.; Contreras, Inés

doi:10.1007/978-1-4939-1086-1_33

Cited by 4 publications

(7 citation statements)

References 80 publications

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“…Surgical management of macular pucker includes peripheral and central core vitrectomy with ILM membrane removal to prevent recurrence. 37 Although there are no true guidelines for surgical intervention, indications for surgery include photoreceptor damage demonstrated on OCT, metamorphopsia, or progressive vision loss. The normal structure of photoreceptor is assessed using OCT by looking at the boundary between the inner and outer segments, which some have defined as the ellipsoid zone, 37 and the interdigitation zone, which is the communication area between inner segments and RPE.…”

Section: Surgery and Vitreoretinal Interfacementioning

confidence: 99%

“…The normal structure of photoreceptor is assessed using OCT by looking at the boundary between the inner and outer segments, which some have defined as the ellipsoid zone, 37 and the interdigitation zone, which is the communication area between inner segments and RPE. 37 – 43 …”

Section: Surgery and Vitreoretinal Interfacementioning

confidence: 99%

“…Intact layer of photoreceptors, good baseline VA, and short-term symptoms are prognostic factors for good surgery outcomes. 18 , 37 However, surgery may change the retinal anatomy even when there is evidence of normal anatomy prior to surgery. Interestingly, foveal architecture is less correlated with good VA because previous data have demonstrated that vision recovery after surgery may occur despite an abnormal foveal contour.…”

Section: Surgery and Vitreoretinal Interfacementioning

confidence: 99%

“…Similar indications are used to guide intervention for pseudoholes and macular holes, and intervention is often combined with a mechanical type of repositioning of the retinal layers, such as gas tamponade. 37 For macular holes, the main indicator of prognosis is the base diameter. A measurement of <500 μm is an indicator of high success rate, 44 , 45 with ILM removal usually indicated for better outcome.…”

Section: Surgery and Vitreoretinal Interfacementioning

confidence: 99%

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Ocriplasmin: who is the best candidate?

Ponce¹,

Stevenson²,

Gelman³

et al. 2016

OPTH

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Enzymatic vitreolysis is currently the focus of attention around the world for treating vitreomacular traction and full-thickness macular hole. Induction of posterior vitreous detachment is an active area of developmental clinical and basic research. Despite exerting an incompletely elucidated physiological effect, ocriplasmin (also known as microplasmin) has been recognized to serve as a well-tolerated intravitreal injection for the treatment of vitreomacular traction and full-thickness macular hole. There are several unexplored areas of intervention where enzymatic vitreolysis could potentially be used (ie, diabetic macular edema). Recent promising studies have included combinations of enzymatic approaches and new synthetic molecules that induce complete posterior vitreous detachment as well as antiangiogenesis. Although no guidelines have been proposed for the use of ocriplasmin, this review attempts to aid physicians in answering the most important question, “Who is the best candidate?”

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Section: Surgery and Vitreoretinal Interfacementioning

confidence: 99%

Section: Surgery and Vitreoretinal Interfacementioning

confidence: 99%

Section: Surgery and Vitreoretinal Interfacementioning

confidence: 99%

Section: Surgery and Vitreoretinal Interfacementioning

confidence: 99%

See 2 more Smart Citations

Ocriplasmin: who is the best candidate?

Ponce¹,

Stevenson²,

Gelman³

et al. 2016

OPTH

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“…Proteolytic activities can cause photoreceptor damage, which may result in visual impairment in more serious cases [18][19][20]. Moreover, the autolytic degradation of ocriplasmin causes its fast inactivation after vitreous injection [21,22].…”

mentioning

confidence: 99%

Mutational Analysis of Ocriplasmin to Reduce Proteolytic and Autolytic Activity in Pichia Pastoris

Baghban

Farajnia

Ghasemi

et al. 2020

Preprint

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Background: Ocriplasmin (Jetrea) is using for the treatment of symptomatic vitreomacular adhesion. This enzyme undergoes rapid inactivation and limited activities duration as a result of its autolytic and proteolytic nature after injection within the eye. Moreover, the proteolytic activities can cause photoreceptor damage, which may result in visual impairment in the more serious cases.Results: The present research aimed to reduce the disadvantages of ocriplasmin using site-directed mutagenesis. To reduce the autolytic activity of ocriplasmin in the first variant, lysine 156 changed to glutamic acid and in the second variant for the proteolytic activity reduction, alanine 59 mutated to threonine. The third variant contained both the mutations. Expression of wild type and three mutant variants of ocriplasmin constructs were done in Pichia pastoris expression system. The mutant variants analyzed in silico and in vitro and compared to the wild type. The kinetic parameters of ocriplasmin variants showed both variants with K156E substitution were more resistant to autolytic degradation than wild-type. These variants also exhibited reduced Kcat and Vmax values. An increase in their Km values, leading to a decreased catalytic efficiency (the Kcat/Km ratio) of autolytic and mix variants. Moreover, in variant with A59T mutation, Kcat and Vmax values have reduced compared to wild type. The mix variants showed the most increase in Km value (almost 2-fold) as well as reduced enzymatic affinity to the substrate. Thus, the results indicated combine mutations at ocriplasmin sequence were more effective compared with single mutations. Conclusions: The results indicated such variants represent valuable tools for the investigation of therapeutic strategies aiming at non-surgical resolution of vitreomacular adhesion.

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Immunology and Pathology in Ocular Drug Development

Ramos

Brassard²,

Masli

2021

Toxicol Pathol

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Clear vision is dependent on features that protect the anatomical integrity of the eye (cornea and sclera) and those that contribute to internal ocular homeostasis by conferring hemangiogenic (avascular tissues and antiangiogenic factors), lymphangiogenic (lack of draining lymphatics), and immunologic (tight junctions that form blood–ocular barriers, immunosuppressive cells, and modulators) privileges. The later examples are necessary components that enable the eye to maintain an immunosuppressive environment that responds to foreign invaders in a deviated manner, minimizing destructive inflammation that would impair vision. These conditions allowed for the observations made by Medawar, in 1948, of delayed rejection of allogenic tissue grafts in the anterior chamber of mouse eye and permit the sequestration of foreign invaders (eg, Toxoplasma gondii) within the retina of healthy individuals. Yet successful development of intraocular drugs (biologics and delivery devices) has been stymied by adverse ocular pathology, much of which is driven by immune pathways. The eye can be intolerant of foreign protein irrespective of delivery route, and endogenous ocular cells have remarkable plasticity when recruited to preserve visual function. This article provides a review of current understanding of ocular immunology and the potential role of immune mechanisms in pathology observed with intraocular drug delivery.

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V.A.2. Vitreomaculopathy Surgery

Cited by 4 publications

References 80 publications

Ocriplasmin: who is the best candidate?

Ocriplasmin: who is the best candidate?

Mutational Analysis of Ocriplasmin to Reduce Proteolytic and Autolytic Activity in Pichia Pastoris

Immunology and Pathology in Ocular Drug Development

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