Tratamiento del síndrome de tracción vitreomacular con plasmina autógena

Abstract

Purpose To determine whether intravitreal injection of autologous plasmin enzyme (APE) is effective in vitreomacular traction syndrome (VMTS) by improving visual acuity and restoring macular morphology. Methods A prospective study of 11 consecutive patients diagnosed with VMTS in the Ophthalmology Department from January to May, 2011. Inclusion criteria: best corrected visual acuity (BCVA) less than 0.5, and vitreomacular attachment in foveal area resulting in macular thickness > 250 microns diagnosed by optical coherence tomography (Cirrus OCT, Carl Zeiss Meditec, Inc, Oberkochen, Germany). Exclusion criteria: active proliferative diabetic retinopathy, axial myopia > 26 mm, vitrectomy, glaucoma, previous intravitreal injections and previous rhegmatogenous detachment. One to 3 monthly intravitreal injections of 0.2 ml of APE were applied, interrupting if posterior vitreous detachment was attained. Wilcoxon's test was used for statistical analysis. Results A total of 12 eyes of 11 patients were treated. A complete posterior vitreous detachment was achieved in 4 (33%) eyes at the end of the study, 2 of them with one injection, and 2 with 3 monthly injections. Improvement of BCVA was statistically significant (P=.017) and the decrease in central macular thickness also was statistically significant (P=.016). There was only one complication: intraocular hypertension after injection that subsided with a new paracentesis. Conclusions Intravitreal APE injections avoided vitrectomy in VMTS in one in every 3 patient