Enzyme-assisted vitrectomy with bacterial collagenase. Pilot human studies.

Area of Science:

• Ophthalmology
• Enzymology
• Surgical Innovation

Background:

• Dense fibroproliferative tissue poses challenges during vitrectomy for conditions like retinopathy of prematurity and diabetic retinopathy.
• Current surgical techniques may struggle with complete removal of such challenging tissue.

Purpose of the Study:

• To evaluate the safety and efficacy of Clostridiopeptidase A as an adjunct in vitrectomy for removing dense fibroproliferative tissue.
• To assess potential side effects associated with intraoperative enzyme use.

Main Methods:

• Clostridiopeptidase A, a bacterial collagenase, was administered intraoperatively to six patients undergoing vitrectomy.
• The enzyme was allowed to incubate for 15 minutes before removal via irrigation/aspiration.
• Patients had conditions including retinopathy of prematurity, diabetic retinopathy, or proliferative vitreoretinopathy.

Main Results:

• No instances of lens opacity, lens dislocation, or retinal hemorrhage were observed post-administration.
• The enzyme facilitated the removal of dense intravitreal fibroproliferative tissue.
• The procedure was successful in assisting membrane stripping in complex cases.

Conclusions:

• Clostridiopeptidase A appears to be a safe and potentially effective adjunct for vitrectomy in specific challenging cases.
• The enzyme may simplify the surgical management of dense fibroproliferative tissue in ocular diseases.
• Further investigation is warranted to establish its broader clinical utility.