In this issue of the BJO (p6), Gandorfer and colleagues contribute to the recent burgeoning of research on enzymatic vitreolysis. Vitreoretinal surgeons, the beneficiaries in recent years of many surgical advances—silicone oil and long acting gas tamponade, perfluorocarbon liquids, photodynamic therapy—nevertheless harbour a collective “wish list” of surgical agents and devices awaiting development. Such a list would include long term heavy liquid tamponade, retinal adhesives, antifibroproliferative drugs, and antiangiogenic treatments. But none figures so prominently as enzymatic vitreolysis, which for years has held the promise of minimally invasive solutions for surgical problems in vitreoretinal diseases such as diabetic retinopathy and macular hole.

The goal is to develop chemicals which when injected into the vitreous produce selective vitreolysis, in the form of either posterior vitreous detachment (PVD) or vitreous liquefaction. Enzymatic vitreolysis is envisaged to augment or even replace standard mechanical vitrectomy, over which it presents important advantages. It offers lower operative risks, less …