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Fibrinolysis in normal vitreous liquid

Bertelmann, Thomasa; Stief, Thomasb; Bölöni, Rekaa; Schulze, Stephana; Wenner, Yaroslavaa; Sekundo, Waltera; Mennel, Stefanc

Blood Coagulation & Fibrinolysis: April 2014 - Volume 25 - Issue 3 - p 217–220
doi: 10.1097/MBC.0000000000000022

Plasmin is the key enzyme of fibrinolysis. Plasmin-alpha2-antiplasmin (PAP) complexes are biomarkers of fibrinolysis activation. The purpose of our investigation was to evaluate the activity of fibrinolysis in normal human eyes, that is in eyes without bloodretina barrier breakdown (BRB), which has not been investigated so far. Twenty-two vitreal samples were harvested at the beginning of a standard 23-gauge three-port pars plana vitrectomy for macular pucker removal, macular hole closure or vitreal floater removal from the central vitreous body. These samples were immediately stabilized with human albumin (2.5% final conc.) and arginine (1.25 mmol/l final conc.) and subsequently frozen. Plasminogen was functionally determined in an ultra-sensitive pNA reaction after activation with streptokinase (100% = functional plasminogen in pooled normal citrated plasma). PAP concentrations were measured by enzyme immune assay (EIA). Intravitreal functional plasminogen exhibited to be 1 ± 0.65% (range: 0.2–2.49%). PAP concentrations ranged at levels of 14 ± 9ng/ml (range: 2–33 ng/ml). Pearson‘s correlation quotient between functional plasminogen and PAP revealed to be r equal to −0.27 (P = 0.221). No adverse events or serious side effects occurred. Sampling vitreous fluid at the beginning of a standard 23-gauge three-port pars plana vitrectomy is a well tolerated procedure. A strict stabilization procedure for extracted vitreous specimen is necessary to obtain activities and concentrations that are close to the true intraocular value. There is a basal intraocular fibrinolysis, a possible target for intravitreal pharmacological therapy.

aDepartment of Ophthalmology

bDepartment of Laboratory Medicine, Philipps-University Marburg, Marburg, Germany

cDepartment of Ophthalmology, Feldkirch Regional Hospital, Feldkirch, Austria

Correspondence to Thomas Bertelmann, MD, Department of Ophthalmology, Philipps-University Marburg, Baldingerstraße, 35043 Marburg, Germany Tel: +49 6421 5861384; e-mail:

Received 24 June, 2013

Revised 23 September, 2013

Accepted 9 October, 2013

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins