Enzymatic Vitreolysis Agent (Ocriplasmin) for Treating Symptomatic Vitreomacular Adhesion

Symptomatic VMA is typically treated with invasive vitreoretinal surgical procedures. The efficacy of these invasive procedures is limited by the potential for incomplete vitreoretinal separation and/or removal, surgical complications (e.g., development of cataracts), and high costs.1 Therefore, a need exists for novel, nonsurgical interventions for vitreoretinal conditions such as VMA.2

Potential targets for antiadhesive interventions are components of the extracellular matrix such as laminin, fibronectin, chondroitin, and integrins, which are thought to act as a "molecular glue" between the vitreous and the retina.3 Animal studies indicate that plasmin, a nonspecific protease, is able to break down fibronectin and laminin, thus promoting posterior vitreous detachment and vitreous liquefaction.3

ThromboGenics NV has developed ocriplasmin (formerly microplasmin), a truncated form of plasmin produced using recombinant methods in a yeast (i.e., Pichia pastoris) expression system, as an intravitreal injection to treat VMA.4,5 Ocriplasmin is intended to provide a pharmacologic means to disrupt adhesion between...