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Published on: June 14, 2021
Autologous in vitreo generated plasmin assisted vitrectomy in the pediatric population
Prema Subramaniam1, Ninan Jacob2, Veerappan Rathinasabapathy Saravanan3
1Department of Pediatric Retina and Ocular Oncology, Postgraduate Institute of Ophthalmology, Aravind Eye Hospital, Coimbatore 641014, Tamil Nādu, India.
Insights
Autologous plasmin enzyme aids vitreoretinal surgery in pediatric patients by improving anatomical outcomes. This method facilitates posterior vitreous detachment (PVD) induction, crucial for successful retinal detachment repair in younger individuals.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Vitreoretinal Surgery
Background:
- Inducing posterior vitreous detachment (PVD) is vital in vitreoretinal surgery but challenging in pediatric patients.
- Autologous plasmin enzyme has shown promise for PVD induction in younger populations.
Purpose of the Study:
- To assess the anatomical and functional results of using in vivo generated autologous plasmin as an adjunct in vitreoretinal surgery for retinal detachment.
- To evaluate the efficacy of autologous plasmin in improving surgical outcomes for pediatric and young adult patients.
Main Methods:
- Retrospective observational case series of ten eyes from nine pediatric patients with retinal detachment.
- Eyes received simultaneous intravitreal injection of autologous blood and tissue plasminogen activator (t-PA) three days prior to vitreoretinal surgery.
Main Results:
- The study included pediatric patients (mean age 9.3 years) with various retinal detachment causes, including high myopia and genetic syndromes.
- No repeat surgeries were needed for recurrent retinal detachment or membrane peeling post-procedure.
- A statistically significant improvement in visual acuity was observed (P=0.01), with five eyes achieving functional vision.
Conclusions:
- Adjunctive intravitreal autologous plasmin enhances anatomical outcomes in pediatric vitreoretinal surgery for retinal detachment.
- Further validation in larger, prospective studies is recommended to confirm these findings.
Background:
Inducing posterior vitreous detachment (PVD) is a crucial step in vitreoretinal surgery. However, compared with older patients, induction of PVD in pediatric and young adult populations is considerably more difficult. Recent studies have shown the utility of autologous plasmin enzyme in inducing PVD in pediatric patients.
Aim:
To evaluate the anatomical and functional outcomes of patients with retinal detachment, treated with in vivo generated autologous plasmin, as an adjunct to vitreoretinal surgery.
Methods:
This is a retrospective observational case series including ten eyes of nine patients with retinal detachment, secondary to various pathologies. All eyes that received simultaneous intravitreal injection of 0.1 mL of autologous blood and 25 μg of tissue plasminogen activator (t-PA) 3 days before surgery were analyzed.
Results:
The mean age of the cohort was 9.3 +/- 4.16 years, ranging from 5 years to 16 years. Four out of nine patients were female. Five of the ten eyes had previously undergone vitreoretinal surgery. In the study cohort, five patients had high myopia, two patients had Stickler's syndrome, one had juvenile X-lined retinoschisis, and one had familial exudative vitreoretinopathy associated with retinal detachment. No eye required repeat vitreoretinal surgery for recurrent retinal detachment or membrane peeling following the primary procedure, with adjunctive intravitreal autologous plasmin the median baseline visual acuity was 2.30 logarithm of the minimum angle of resolution (LogMAR) [interquartile range (IQR): 1.85-2.60], and the median final visual acuity was 1.54 LogMAR (IQR: 1.08-1.78), showing a statistically significant improvement (P = 0.01), with five eyes regaining functional visual acuity.
Conclusion:
Adjunctive intravitreal autologous plasmin improves the anatomical outcome of vitreoretinal surgery in pediatric patients. However these findings require validation in a large sample, prospective study.
