[Using enzymes in the posterior eye segment. Current status and future possibilities]

Area of Science:

• Ophthalmology
• Biochemistry
• Retinal Diseases

Background:

• Enzymatic treatments for posterior segment eye diseases have been explored for 40 years.
• Pars plana vitrectomy is effective for vasoproliferative vitreoretinal diseases but is invasive.
• Acute subretinal hemorrhage can be treated with enzymatic fibrinolysis and gas tamponade.

Purpose of the Study:

• To review the current applications and future potential of enzymatic therapies in ophthalmology.
• To evaluate enzymatic approaches for treating subretinal hemorrhage and vitreoretinal disorders.
• To explore enzymatic destruction of growth factors and extracellular matrix proteins for novel therapeutic strategies.

Main Methods:

• Intravitreal injection of enzymes like tissue plasminogen activator (TPA) for subretinal fibrinolysis.
• Testing enzymes such as collagenase, hyaluronidase, dispase, plasmin, TPA, and chondroitinase for vitreous liquefaction or cortex cleavage.
• Investigating enzymatic degradation of vascular endothelial growth factor (VEGF) and fibronectin.

Main Results:

• Intravitreal TPA demonstrated effective subretinal fibrinolysis in morphometric analyses.
• TPA successfully treated acute subretinal hemorrhage, replacing pars plana vitrectomy.
• Limited clinical studies have utilized TPA, plasmin, and hyaluronidase.

Conclusions:

• Enzymatic therapy combined with pneumatic displacement is a viable, less invasive treatment for subretinal hemorrhage.
• Enzymes hold potential for managing vasoproliferative vitreoretinal diseases by targeting vitreous components and growth factors.
• Future therapies may involve enzymatic vitreous cleaning to prevent proliferative diabetic retinopathy.