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DefinitionDiabetic retinopathy is a microvascular complication of diabetes affecting the retinal blood vessels.Risk FactorsDiabetic retinopathy is present in almost all individuals with type 1 diabetes and more than 60% of those with type 2 diabetes after two decades of disease.The risk increases with poor glycemic control, hypertension, dyslipidemia, smoking, pregnancy, and puberty.Although cataracts and glaucoma are also more frequent in people with diabetes, retinopathy remains the leading...

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Ocriplasmin for diabetic retinopathy.

Marc D de Smet¹, Miguel Castilla

¹Retina and Inflammation division, MIOS sa , Avenue du Léman 32, Lausanne 1005 , Switzerland mddesmet1@mac.com.

Expert Opinion on Biological Therapy

|November 12, 2013

Summary

Pharmacologic vitreolysis using ocriplasmin may induce posterior vitreous detachment (PVD) to prevent advanced diabetic retinopathy (DR). Further trials are needed to confirm efficacy in preventing PDR and treating diabetic macular edema (DME).

Area of Science:

Ophthalmology
Retinal Diseases
Pharmacology

Background:

Diabetic retinopathy (DR) is a leading cause of vision impairment, with proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) being major concerns.
Posterior vitreous detachment (PVD) is associated with a reduced risk of PDR and improved outcomes in DME.
Pharmacologic vitreolysis offers a potential minimally invasive approach to induce PVD and prevent advanced DR.

Purpose of the Study:

To review the epidemiology of DR and the role of PVD.
To examine the principles and challenges of pharmacologic vitreolysis for inducing PVD.
To analyze ocriplasmin's efficacy in clinical trials for potential use in DR.

Main Methods:

Review of current diabetic retinopathy epidemiology.

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Analysis of a meta-analysis on PVD's contribution to PDR and DME.

Examination of vitreolysis principles and ocriplasmin clinical trial results.

Main Results:

Ocriplasmin effectively liquefies vitreous and induces PVD in a significant number of patients.
A single ocriplasmin injection may not be sufficient to achieve complete PVD in most cases.
Complete PVD is crucial for reducing PDR risk; partial PVD may worsen prognosis.

Conclusions:

Achieving complete PVD with vitreolytic agents like ocriplasmin could be a viable strategy for PDR prevention.
Vitreolysis may benefit DME by releasing traction, potentially improving vision.
Randomized clinical trials are essential to evaluate ocriplasmin's efficacy in DR compared to existing treatments like prophylactic laser.