A New Pharmacological Vitreolysis through the Supplement of Mixed Fruit Enzymes for Patients with Ocular Floaters or Vitreous Hemorrhage-Induced Floaters.

Purpose: Ocular floaters caused by vitreous degeneration or blood clots may interfere with various visual functions. Our study investigated the pharmacologic effects of oral supplementation of mixed fruit enzymes (MFEs) for treating spontaneous symptomatic vitreous opacities (SVOs) and those secondary to vitreous hemorrhage (VH). Methods: 224 patients with monocular symptomatic vitreous opacities (SVOs) were recruited between September and December 2017 and received oral supplementation of MFEs (190 mg bromelain, 95 mg papain, and 95 mg ficin) for 3 months in a double-blind clinical trial. Participants were divided according to the etiology of the SVOs, spontaneous (experiment 1) versus VH (experiment 2), and then randomly assigned into four treatments groups: one group received oral vitamin C, as a placebo; and the other 3 groups received 1 capsule per day (low dose), 2 capsules per day (middle dose), or 3 capsules per day (high dose) of MFEs. The number of SVOs was determined at baseline and then 1, 2, and 3 months after initiating treatment. Further, in cases secondary to VH, the changes in corrected distance visual acuity (CDVA) were assessed after 3 months. Second, we compared the free radical scavenging capabilities of each substance: vitamin C, bromelain, papain, ficin, and MFEs (combination of bromelain, papain, and ficin) by DDPH assay. Finally, SVOs-related symptoms and satisfaction with the treatments were evaluated at the last follow-up visit Results: In experiment 1, the disappearance rate of SVOs was 55%, 62.5%, and 70% after taking 1, 2, and 3 capsules daily, respectively (total p < 0.001), in a dose-dependent manner. In experiment 2, the disappearance rate of VH-induced SVOs was 18%, 25%, and 56% (p < 0.001) after 1, 2, and 3 capsules of the supplement daily, respectively. Additionally, the patients' vision elevated from 0.63LogMAR to 0.19LogMAR (p = 0.008). Conclusions: A pharmacological approach using a high dose of oral supplementation with MFEs (bromelain, papain, and ficin) was effective in reducing vitreous opacities, even after intraocular hemorrhage. Furthermore, pharmacologic vitreolysis with MFEs supplementation showed high patient satisfaction, and also improved CDVA in patients with vitreous hemorrhage-induced floaters

Effect of vitrectomy timing on long-term efficacy in patients with vitreous hemorrhage due to proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the timing and efficacy of vitrectomy for patients with vitreous hemorrhage(VH) due to proliferative diabetic retinopathy(PDR).METHODS:Retrospective analysis.Patients who presented to our hospital between Feburary 2012 and May 2014 with VH secondary to PDR treated with vitrectomy were included.All patients were divided into three groups according to the duration of VH.A group was less than 1mo for 22 eyes, B group was 1-3mo for 23 eyes, C group was more than 3mo for 25 eyes.All patients underwent intravitreal injection of ranibizumab 1-2wk before vitrectomy, and supplemented or finished panretinal photocoagulation (PRP) intraoperatively or postoperatively.Patients with cataract accepted phacoemulsification and intraocular lens implantation.Eyes filling silicone oil were implanted intraocular lens in the second phase.All patients were followed up 24 to 42mo (mean:28.7mo).We assessed the intraoperative complications such as hemorrhage, iatrogenic retinal hole, and postoperative complications such as vitreous hemorrhage, neovascular glaucoma.Macular edema and best corrected visual acuity were observed at every follow-up.RESULTS:There was no significant difference for other baseline data (P>0.05) but DR stage between three groups (P=0.033).There was significant difference of last follow up visual acuity between three groups (P0.05).The percentage of visual acuity was 0.5 and above in the three groups were:41%, 23%, 0 respectively.The patients with visual acuity of less than 0.1 were 5%, 26% and 40% respectively.Silicone oil filling rate of three groups were:9%, 26%, 40% respectively and there was no significantly difference between three groups on postoperative complications (P>0.05).CONCLUSION:Patients with VH due to proliferative diabetic retinopathy undergoing early vitrectomy may get better visual acuity than who accepting delayed vitrectomy.

Hyaluronidase with α - lipoic acid and Chinese medicine in the treatment of diabetic vitreous hemorrhage / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To study the effectiveness of hyaluronidase periocular injection combined with α - lipoic acid and Chinese medicine in the treatment of diabetic vitreous hemorrhage. METHODS: Retrospective analysis of 67 patientswith proliferative diabetic retinophathy ( PDR ) and vitreous hemorrhage, were divided into two groups: treatment group and control group. There were 32 cases in every group, the treatment group were giving hyaluronidase periocular injection combined with α - lipoic acid intravenously and with traditional Chinese medicine in promoting blood circulation to remove blood stasis, control group were only given Chinese medicine treatment in promoting blood circulation to remove blood stasis. RESULTS: Followed up 2-3mo, the total efficiency of treatment group ( 78%) was better than control group (57%), there was statistically significant difference ( P0. 05). CONCLUSION: Hyaluronidase periocular injection combined with α-lipoic acid and Chinese medicine in the treatment of PDR combined with vitreous hemorrhageis more effective than only use Chinese medicine. But it only has effect for the early, over 2wk, it has no significant effect.

Outcomes analysis after vitrectomy of polypoidal choroidal vasculopathy combined with vitreous hemorrhage / 中国医师进修杂志

Objettive To evaluate the effect of taking vitrectomy on the patients who suffer from polypoidal choroidal vasculopathy (PCV) combined with vitreous hemorrhage (VH),observe the natural consequence of PCV combined with VH and analyze the factors that affected the visual prognosis.Methods The clinical data of 20 patients with PCV combined with VH who performed vitrectomy were analyzed retrospectively from January 2009 to September 2012.Best corrected visual acuity (BCVA) was compared before and after operation,and explored the factors that affected the visual prognosis.Results Patients were followed up 6-18 (13 ± 2) months.At the last follow-up,BCVA was improved and better than 0.05 in 11eyes.There was significant difference in BCVA between before operation (2.91 ±0.52) and 2 weeks after operation (1.52 ±0.51)(P =0.003).The natural factors between visual acuity improved patients and non-improved patients were compared,follow-up treatment and the condition of macular was the independent factor that affected the visual prognosis (P =0.009,0.034).There was significant difference in BCVA of 6months after operation between patients with follow-up treatment (photedynamic therapy or transpupillary thermotherapy,10 cases) and patients without follow-up treatment (10 cases)(0.77 ± 0.51 vs.1.43 ± 0.64)(P =0.035).Conclusions Vitrectomy can significantly improve the visual acuity of PCV combined with VH.It will get better visual acuity,if has photodynamic therapy or transpupillary thermotherapy postoperatively.

Retina protection effect of Huwang Mingmu San in experimental vitreous hemorrhage / 中华中医药杂志

Objective:The purpose of this study was to observe Huwang Mingmu San’s(HWMMS)effect on the experimental vitreous hemorrhage.Methods:We divided 48 rabbits randomly into the A group as the normal control group,the B group as the modal group,the C group as the traditional chinese medicine group(HWMMS)and the D group as the western medicine group(entodan).Six rabbits of the four groups were killed randomly in the 8th week and their vitreous send to TNF-?,IL-6 examination at the same time.We study the activity level of MDA,SOD,NA-K-ATP enzyme on retinal.Results: It was suggested that the TNF-?’s content in HWMMS group had significantly increased than that in the normal group and the model group but no difference was found between the HWMMS group and the entodan group.Meanwhile the results showed that the HWMMS group’s content of IL-6 and MDA was lower and SOD activity,NA-K-ATP enzyme content was higher than those in the model group and the entodan group.Conclusion:We concluded that the HEMMS had a remarkable therapeutic effect on retinal damage and in promoting absorption vitreous hemorrhage.