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Clinical pharmacy and clinical trials (including case series)
Pharmacological vitrectomy with urokinase: description of the method and review of a case series.
  1. L. Hoyo Gil,
  2. S. Sánchez Suarez,
  3. A. Martín Bravo,
  4. L. Sastre Gallego,
  5. N. López Ferrando
  1. 1Hospital El Escorial, Pharmacy Service, San Lorenzo de El Escorial, Spain
  2. 2Hospital El Escorial, Ophtalmology Service, San Lorenzo de El Escorial, Spain

Abstract

Background Pharmacological vitrectomy (PV) with autologous plasmin is used to detach the vitreous, with or without subsequent surgical vitrectomy, in several pathologies such as proliferative diabetic retinopathy, proliferative vitreoretinopathy, macular hole, posterior hyaloid contracture syndrome and vitreomacular traction syndrome. Autologous plasmin is obtained by an expensive and complicated method. An alternative method is the use of urokinase as an enzymatic activator of the plasmin; it is cheap and simple to make.

Purpose To describe the technique and our experience with it during the first year of use in our hospital.

Materials and methods The steps are as follows: 1- Take 7 ml of blood from the patient, place in the centrifuge tube and centrifuge at 4,000 rpm for 15 min. Simultaneously, a phial of urokinase is heated for 15 min at 37°C. 2- Mix 1.8 ml of plasmin with 0.2 ml of urokinase, shaking the mixture vigorously for another 2-3 min, keeping the mixture in incubation at 37°C until use. 3- Sterilise the solution by filtration through a 0.22 mm filter, immediately preceding the injection of 0.2 ml into the eye.

Results Over this year using this technique in our hospital 17 patients have been treated with it, in 3 of them the procedure had to be repeated. An improvement in visual acuity was observed in 62.5% of these patients one month after the intervention but was not associated with an improvement in retinal anatomy.

Conclusions PV is a cheaper, faster and easier technique than the operation used prior to PV. PV is an interesting technique to perform in hospitals that do not have retinal surgery or in patients with comorbidities that contraindicate vitrectomy under anaesthesia.

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