Autologous Plasmin Assisted Vitrectomy for Stage 5 Retinopathy of Prematurity

Abstract

Purpose: : To study the efficacy and safety of autologous plasmin assisted vitrectomy for stage5 retinopathy of prematurity(ROP) .

Methods: : Consecutive six eyes of four children were treated. Their gestational age was 24 to 26 weeks (mean: 25.0) and birth weight was 652 to 811 grams (mean:701.3). Age at the operation was 5 to 8 months (mean:6.3) after birth. After institutional review board approval, informed consent was obtained from parents of each patient. Autologous plasmin was prepared from patient’s plasma by affinity chromatography. Surgery was performed using limbal approach 23G three–port system. Additional two ports at the limbus was made for easier dissection of peripheral membrane in two cases. After lensectomy, appropriate dissection and removal of proliferative membrane, 0.03 to 0.22 IU of autologous plasmin in 0.1 to 0.15ml solution was administrated into the vitreous cavity. After 20 to 30 minute incubation, residual proliferative membrane was removed. Plasmin was administrated repeatedly in four cases.

Results: : Proliferative membrane was removed without making iatrogenic retinal break and reattachment of posterior pole retina was achieved in all eyes at their last follow–up (4 to 8 months, mean 6.3). Slight fibrin reaction was observed in all eyes postoperatively, which disappeared in several days. No other complication was observed.

Conclusions: : This study suggests the benefit of autologous plasmin during vitrectomy for stage5 ROP.

Keywords: retinopathy of prematurity • vitreoretinal surgery • enzymes/enzyme inhibitors