Pharmacologic vitreolysis with tissue plasminogen activator

Abstract

In the late 1980s and early 1990s, it was assumed that vitrectomy is a perfect tool to handle most vitreoretinal diseases even in cases of vitreo-macular traction. However, vitrectomy surgery includes risks like retinal detachment, hemorrhages, cataract formation, and infections. To avoid these problems, there is a need for a pharmacologic approach called pharmacologic vitreolysis. Even though the use of enzymes in ophthalmology has a long history, some of these enzymes, like hyaluronidase [47] and collagenase [43], were investigated long before vitrectomy was introduced. Further investigations for liquefaction and posterior vitreous detachment since the beginning 1990s with different types of enzymes have been reported. Streptokinase [5], hyaluronidase [11, 3], nattokinase [60], and chondroitinase [12, 3, 58, 13] were investigated but had significant side effects or insufficient clinical efficacy.