Pharmacologic Vitreolysis

Vitreoretinal interface disorders include vitreomacular traction, epiretinal membrane, and vitreomacular traction syndrome. Vitreomacular traction syndrome (VMT) is a disorder of the vitreoretinal interface characterized by an incomplete separation of the posterior vitreous from the retina, resulting in anterior-posterior tractional forces that distort the macula and cause a decline in visual function. Spontaneous or induced (surgical or pharmacologic) vitreous separation from the retina resolves such tractional forces and may help with the normalization of the macular anatomy. Pharmacologic vitreolysis is a non-invasive treatment option for VMT and macular holes. Enzymatic and non-enzymatic agents have been studied as a stand-alone or adjunct treatment before vitrectomy surgery to facilitate the separation of the posterior vitreous from the retina. Food and Drug Administration (FDA) approval of ocriplasmin created hopes for nonsurgical treatment of vitreoretinal interface disorders. However, the medicine did not gain widespread approval. In this article, we will briefly review the pathologies of the vitreoretinal interface and the pharmacologic agents proposed for vitreolysis. Then, we will focus on the clinical studies on ocriplasmin, its indications and outcomes, and the complications associated with the use of ocriplasmin.