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Ocriplasmin for diabetic retinopathy

机译：Ocriplasmin治疗糖尿病性视网膜病

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Introduction: Diabetic retinopathy is a serious public health concern. Vision impairment follows from intraocular vascular proliferation known as proliferative diabetic retinopathy (PDR) and/or from diabetic macular edema (DME). Clinical acumen and a recent meta-analysis of published studies suggest that the presence of a posterior vitreous detachment (PVD) reduces the risk of developing PDR, and has a favourable impact on DME. Pharmacologic vitreolysis by ocriplasmin or other agents may provide a minimally invasive method of achieving a PVD. If demonstrated in appropriate clinical studies including randomized trials, it would provide an interesting approach to prevent advanced and blinding stages of diabetic retinopathy, particularly in areas where access to care is limited. Areas covered: The current epidemiology of diabetic retinopathy is reviewed as well as the role of the vitreous and its separation from the retina known as a PVD in DR based on a recent meta-analysis of published literature regarding the contribution of complete, partial or absent PVD to PDR and DME. The principles underlying vitreolysis and the induction of PVD are reviewed as well as the challenges faced by a pharmacologic approach. The results of clinical trials on the use of ocriplasmin are analyzed regarding its possible use in DR. Expert opinion: Ocriplasmin has the ability to liquefy the vitreous and induce a PVD in a statistically significant number of patients. However, current studies on patients with vitreomacular adhesion and traction suggest that the majority of patients would not achieve a PVD with a single injection. As shown in the meta-analysis, a complete PVD is required to significantly reduce the risk of PDR, while a partial PVD may worsen the prognosis. If a strategy can be developed that insures a complete PVD within an appropriate time interval, the prevention of PDR might become a realistic target for ocriplasmin or other vitreolytic agents. In DME, release of traction whether complete or partial is associated with a reduction in DME, which in several cases has resulted in improved vision. While no studies have been conducted on the use of ocriplasmin or other vitreolytic agents in DR, a few studies using plasmin indicate that it is likely to have a beneficial effect in DME. Based on the information available, randomized clinical trials would be required to evaluate the clinical relevance of ocriplasmin and other potential vitreolytic agents in both forms of DR. Such trials could determine the efficacy of this strategy as compared to prophylatic laser particularly in high-risk populations. New follow-up and treatment strategies would also be required should initial studies be encouraging.
机译：简介：糖尿病性视网膜病是严重的公共卫生问题。视力障碍来自被称为增生性糖尿病视网膜病变（PDR）的眼内血管增生和/或糖尿病性黄斑水肿（DME）。临床敏锐度和最近发表的研究的荟萃分析表明，玻璃体后脱离（PVD）的存在降低了发生PDR的风险，并对DME具有有利的影响。通过眼球蛋白或其他药物进行药物玻璃化可以提供一种实现PVD的微创方法。如果在包括随机试验在内的适当临床研究中得到证实，它将为预防糖尿病性视网膜病的晚期和致盲期提供一种有趣的方法，尤其是在获得医疗服务有限的地区。涵盖的领域：根据最近发表的有关完全，部分或不存在的文献的荟萃分析，综述了糖尿病性视网膜病的流行病学以及玻璃体的作用及其与视网膜中称为PVD的视网膜的分离PVD到PDR和DME。审查了玻璃体分解和PVD诱导的基本原理以及药理学方法面临的挑战。分析了使用Ocriplasmin的临床试验结果，探讨了其可能在DR中的使用。专家意见：在统计上有统计学意义的大量患者中，Ocriplasmin能够液化玻璃体并诱导PVD。但是，目前对玻璃体粘连和牵引患者的研究表明，大多数患者单次注射无法达到PVD。如荟萃分析所示，需要完整的PVD才能显着降低PDR的风险，而部分PVD可能会使预后恶化。如果可以制定确保在适当的时间间隔内完成PVD的策略，则预防PDR可能会成为Ocriplasmin或其他玻璃体溶解剂的现实目标。在DME中，完全或部分牵引力的释放与DME的减少有关，在某些情况下，这会改善视力。尽管尚无关于在DR中使用环氧纤溶酶或其他玻璃体溶解剂的研究，但一些使用纤溶酶的研究表明，它可能对DME具有有益作用。根据可用的信息，将需要随机临床试验来评估两种形式的DR中的Ocriplasmin和其他潜在的玻璃体溶解剂的临床相关性。与预防性激光相比，此类试验可以确定该策略的有效性，特别是在高风险人群中。如果初步研究令人鼓舞，也将需要新的随访和治疗策略。

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