Considerable interest exists in enzyme preparations that can be injected into the vitreous cavity to aid in clearing blood from the vitreous and inducing PVD. Enzymes that have been proposed for injection include hyaluronidase, plasmin, dispase, and chondroitinase. Clinical trials with hyaluronidase and collagenase failed to induce PVD. However, ocriplasmin, which cleaves fibronectin and laminin (see Fig 11-3), was better able to induce PVD than placebo and demonstrated efficacy in nonsurgical management of vitreomacular traction and macular holes. Subsequently, there have been reports describing retinal changes on optical coherence tomography and altered electroretinogram following administration of ocriplasmin (see also BCSC Section 12, Retina and Vitreous).
Fahim AT, Khan NW, Johnson MW. Acute panretinal structural and functional abnormalities after intravitreous ocriplasmin injection. JAMA Ophthalmol. 2014;132(4):484–486.
Gandorfer A. Enzymatic vitreous disruption. Eye (Lond). 2008;22(10):1273–1277.
Stalmans P, Benz MS, Gandorfer A, et al. Enzymatic vitreolysis with ocriplasmin for vitreomacular traction and macular holes. N Engl J Med. 2012;367(7):606–615.
Tibbetts MD, Reichel E, Witkin AJ. Vision loss after intravitreal ocriplasmin: correlation of spectral-domain optical coherence tomography and electroretinography. JAMA Ophthalmol. 2014;132(4):487–490.
Excerpted from BCSC 2020-2021 series: Section 2 - Fundamentals and Principles of Ophthalmology. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.