Subramaniam P, Jacob N, Saravanan VR, Shah PK, Das A, Venkatapathy N. Autologous in vitreo generated plasmin assisted vitrectomy in the pediatric population. World J Clin Pediatr 2026; 15(3): 120868 [DOI: 10.5409/wjcp.120868]
Corresponding Author of This Article
Parag K Shah, Professor, Department of Pediatric Retina and Ocular Oncology, Postgraduate Institute of Ophthalmology, Aravind Eye Hospital, Avinashi Road, Coimbatore 641014, Tamil Nādu, India. drshahpk2002@yahoo.com
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Ophthalmology
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research-article
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Subramaniam P, Jacob N, Saravanan VR, Shah PK, Das A, Venkatapathy N. Autologous in vitreo generated plasmin assisted vitrectomy in the pediatric population. World J Clin Pediatr 2026; 15(3): 120868 [DOI: 10.5409/wjcp.120868]
World J Clin Pediatr. Sep 9, 2026; 15(3): 120868 Published online Sep 9, 2026. doi: 10.5409/wjcp.120868
Autologous in vitreo generated plasmin assisted vitrectomy in the pediatric population
Narendran Venkatapathy, Abhishek Das, Parag K Shah, Veerappan Rathinasabapathy Saravanan, Ninan Jacob, Prema Subramaniam
Prema Subramaniam, Parag K Shah, Abhishek Das, Narendran Venkatapathy, Department of Pediatric Retina and Ocular Oncology, Postgraduate Institute of Ophthalmology, Aravind Eye Hospital, Coimbatore 641014, Tamil Nādu, India
Ninan Jacob, Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Coimbatore 641004, Tamil Nādu, India
Veerappan Rathinasabapathy Saravanan, Department of Vitreoretina, Aravind Eye Hospital, Coimbatore 641014, Tamil Nādu, India
Co-first authors: Prema Subramaniam and Ninan Jacob.
Author contributions: Subramaniam P, Saravanan VR, Shah PK, Venkatapathy N designed the research; Subramaninam P, Saravanan VR, Jacob N, Das A performed the research. Subramaniam P and Jacob N contributed equally to this work as co-first authors.
Institutional review board statement: The study was reviewed and approved by the Institutional review board of Aravind Eye Hospital, Madurai Institutional Review Board, No. RET202200528.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No conflicts of interest.
Data sharing statement: Participants gave informed consent for data sharing.
Corresponding author: Parag K Shah, Professor, Department of Pediatric Retina and Ocular Oncology, Postgraduate Institute of Ophthalmology, Aravind Eye Hospital, Avinashi Road, Coimbatore 641014, Tamil Nādu, India. drshahpk2002@yahoo.com
Received: March 11, 2026 Revised: April 17, 2026 Accepted: June 22, 2026 Published online: September 9, 2026 Processing time: 142 Days and 15.6 Hours
Abstract
BACKGROUND
Inducing posterior vitreous detachment (PVD) is a crucial step in vitreoretinal surgery. However, compared with older patients, induction of PVD in pediatric and young adult populations is considerably more difficult. Recent studies have shown the utility of autologous plasmin enzyme in inducing PVD in pediatric patients.
AIM
To evaluate the anatomical and functional outcomes of patients with retinal detachment, treated with in vivo generated autologous plasmin, as an adjunct to vitreoretinal surgery.
METHODS
This is a retrospective observational case series including ten eyes of nine patients with retinal detachment, secondary to various pathologies. All eyes that received simultaneous intravitreal injection of 0.1 mL of autologous blood and 25 μg of tissue plasminogen activator (t-PA) 3 days before surgery were analyzed.
RESULTS
The mean age of the cohort was 9.3 +/- 4.16 years, ranging from 5 years to 16 years. Four out of nine patients were female. Five of the ten eyes had previously undergone vitreoretinal surgery. In the study cohort, five patients had high myopia, two patients had Stickler’s syndrome, one had juvenile X-lined retinoschisis, and one had familial exudative vitreoretinopathy associated with retinal detachment. No eye required repeat vitreoretinal surgery for recurrent retinal detachment or membrane peeling following the primary procedure, with adjunctive intravitreal autologous plasmin the median baseline visual acuity was 2.30 logarithm of the minimum angle of resolution (LogMAR) [interquartile range (IQR): 1.85-2.60], and the median final visual acuity was 1.54 LogMAR (IQR: 1.08-1.78), showing a statistically significant improvement (P = 0.01), with five eyes regaining functional visual acuity.
CONCLUSION
Adjunctive intravitreal autologous plasmin improves the anatomical outcome of vitreoretinal surgery in pediatric patients. However these findings require validation in a large sample, prospective study.
Core Tip: Posterior vitreous detachment (PVD), a key to the success in all vitreoretinal surgeries, is a crucial and challenging step in pediatric vitreoretinal surgeries especially syndromic retinal detachments. Surgical success is not fruitful even in experienced hands. The use of enzymatic vitreolysis (with plasmin) is promising in PVD induction, but unfortunately its usage is restricted due to the limitation in procuring these less durable enzymes. This method of in vivo plasmin generation by injecting a readily available agent (autologous whole blood) and tissue plasminogen activator yields plasmin inside the vitreous cavity and help in PVD induction henceforth surgical success. This retrospective pilot study will be beneficial for practicing vitreoretinal surgeons.
