摘要近年来随着OCT技术的演变发展,玻璃体视网膜交界面疾病逐渐成为关注和研究热点.不完全的玻璃体后脱离(posterior vitreous detachment,PVD)往往会导致玻璃体黄斑粘连(vitreomacular adhesion,VMA)及其相关的一系列并发症.与传统玻璃体切除术相比,利用酶辅助或替代性治疗具有更加安全、便捷的优势.本文就不同酶制剂在诱导PVD以及治疗VMA相关性疾病的实验和临床方面展开综述.第一代酶溶剂如透明质酸酶、硫酸软骨素酶、分散酶、纤溶酶、纤溶酶原激活剂等因有效性与安全性等因素在临床研究和应用十分有限.第二代酶溶剂奥克纤溶酶临床上玻璃体黄斑牵拉(vitremacular traction,VMT)释放率和全层黄斑裂孔(full-thickness macular hole,FTMH)闭合率要高于“玻璃体注射奥克纤溶酶缓解牵拉而非手术治疗”(MIVI-TRUST)试验,是目前治疗VMA相关疾病的首选酶溶剂,其常见不良反应为注射后短暂的视力下降、闪光感、视物变暗、结膜充血、高眼压等,伴随黄斑病变者应慎重使用.

abstractsWith the development of OCT technology in recent years,vitreoretinal interface diseases have become the focus of attention and research gradually.Incomplete posterior vitreous detachment (PVD)can lead to vitreomacular adhesion (VMA) and a series of related complications.Compared with traditional vitrectomy,enzyme-assisted or alternative therapy is safer and more convenient.This article reviewed the experimental and clinical studies of different enzymes in inducing PVD and treating VMA-related diseases.The first-generation enzymatic agents,such as hyaluronidase,chondroitinase,dispase,plasmin and tissue plasminogen activator (TPA),are limited in clinical research and application because of their effectiveness and safety.As the second-generation enzymatic agents,the efficacy of intravitreal ocriplasmin for both vitreomacular traction (VMT) syndrome and full-thickness macular hole (FTMH) is better than MIVI-TRUST(microplasmin for intravitreous injection-traction release without surgical treatment) trial.At present,ocriplasmin is the first choice for the treatment of VMA and related diseases.The common complications of intravitreal ocriplasmin include transient blurred vision,photopsia,dyschromatopsia,conjunctival hyperemias,elevated intraocular pressure,etc.Patients with macular degeneration should be used prudently.