Haritoglou C, Kampik A
Augenklinik , Ludwig-Maximilians-Universität, Mathildenstr. 8, 80336, München, Deutschland,
Ophthalmologe. 2013 Oct;110(10):935-40. doi: 10.1007/s00347-013-2829-7.
Posterior vitreous detachment (PVD) is a physiological ageing process. In many cases PVD is incomplete and pathological adhesions of vitreous collagen may be associated with tractional forces in the periphery where they can cause retinal breaks and lead to detachment of the neurosensory retina. In the macular area such tractional forces at the vitreoretinal interface can contribute to the formation of specific entities such as vitreomacular traction syndrome and macular holes which are associated with an impairment of visual acuity and disturbing metamorphopsia. Currently, pars plana vitrectomy with induction of PVD, peeling of epiretinal membranes and the ILM represents an effective and safe treatment option for these conditions. Pharmacological vitreolysis is a new and alternative, non-surgical approach to release tractional forces at the vitreoretinal interface by injecting an enzyme with proteolytic activity against fibronectin and laminin into the vitreous cavity. Certain forms of vitreomacular traction and smaller macular holes can be successfully treated in this way without surgical manipulation of the retinal surface. The role of the concept of pharmacological vitreolysis as a treatment option even for exudative macular diseases or as an adjunct to assist vitreoretinal surgical procedures is currently under investigation.
玻璃体后脱离（PVD）是一种生理性老化过程。在许多情况下，PVD并不完全，玻璃体胶原的病理性粘连可能与周边的牵拉力有关，在周边部位牵拉力可导致视网膜裂孔并引起神经感觉视网膜脱离。在黄斑区，玻璃体视网膜界面的这种牵拉力可促使特定病变的形成，如玻璃体黄斑牵拉力综合征和黄斑裂孔，这些病变与视力损害和令人困扰的视物变形有关。目前，行玻璃体切割术诱发PVD、剥除视网膜前膜和内界膜是治疗这些疾病有效且安全的选择。药物性玻璃体溶解术是一种新的、替代性的非手术方法，通过向玻璃体腔注射一种对纤连蛋白和层粘连蛋白具有蛋白水解活性的酶来解除玻璃体视网膜界面的牵拉力。某些类型的玻璃体黄斑牵拉和较小的黄斑裂孔可以通过这种方式成功治疗，而无需对视网膜表面进行手术操作。药物性玻璃体溶解术作为一种治疗选择，甚至对于渗出性黄斑疾病，或作为玻璃体视网膜手术的辅助手段，其作用目前正在研究中。
