Journal of American Science 2019;15(4) http://www.jofamericanscience.

org

Pharmacologic vitreolysis of vitreous floaters by 3-month pineapple supplement in Taiwan: a pilot study

Chi-Ting Horng 1,2,5, Fu-An Chen1,5, Daih-Huang Kuo1, Li-Chai Chen1, Shou-Shan Yeh3, Shuan-Yu Huang4, and
Po-Chuen Shieh1,*
1
Department of Pharmacy, Tajen University, Pingtung, Taiwan, ROC.
2
Departmet of Opthalmolgy, Fooying University Hospital, Pingtung, Taiwan, ROC.
3
Kaohsiung City Government, Kaohsiung, Taiwan, ROC.
4
School of Optometry, Chunmg Shan Medical Hospital, Taichung, Taiwan, ROC.
5
These authors contributed equally to the paper.
*
Corresponding author: Po-Chuen Shieh Ph.D.; E- mail: [email protected]

Abstract: Purpose: This survey is the first one in world to evaluate the pharmacolytic effects of the pineapples for
floaters. Indifferent designs, we followed the results of patients who took various doses of pineapples each day for 3
months. Methods: The studies and sources of crude pineapples were all scheduled between 2016 March with June
2016 in sourthern Taiwan including City Tainan, Koahsiung and Pintung. The delicious and well- benefit pineapples
were famous and supplied by the local farmers selling to the world by trades since 1900. In this studies, 388
participants were arrangged to undergo series of ocular examinationsn during the series of experimets. In experiment
1, 190 subjects were classified into group 1 (one floater) and group 2 (multiple floaters) and they all took 2 pieces of
pineapples after lanuch every day for 3 months. In experiment 2, the 198 eyes with various vitreous floaters were
classified into 3 groups by chance according to the extent of pineapple intake including low pineapple group (LPA),
middle pineapple group (MPA) and high pineapple group (HPA). In all experiments, our staffs cut into one piece of
pineapple with 100 gram grossly. Regular intake of pineapples is good for health-promotion and even
cancer-prevention; however, preventing from the higher blood glucose and caloric restriction daily, the reasonable
amount of pineapple is 2-3 pieces within healthy ones. In our experiment 2, the amounts of oral pineapples in LPA.
MPA, and HMP were 1, 2, and 3 pieces after lunch each day, respectively. Results: In experiment 1,100% subjects
of one floater (120 eyes) subsides to only 29.2% (35/120) after 3-month-therapy. Besides, 70 participants with
multiple floaters decreased to 19 cases (27.1%; 19/70) three months later. In a world, the extract pineapple may
enhance floaters disappearance. In experiment 2, groups 1-3, (each group = 66 eyes) were choose randomly to
different supplements including the LAP, MAP and HAP intake also for 3 months. It is surprised that from
pineapple may increase the rate of disappearance of vitreous opacity. The percentage of decrease of floaters by
taking the pineapples was 45.5%, 37.8% and 30.2% and 1, 2, 3 pieces, respectively. It also showed that pineapples
for treating the patients with floaters with dose-dependent manner. In addition, the protocols for therapy of the
floaters were no special side effects. Furthermore, the mechanisms of dissolving floaters may be to cut and clear the
vitreous fibrils and to scavenge the free radicals which could result in hyaluronic acid degradation and vitreous
floater formation. Conclusion: We found that taking pineapples should diminish the persistence of floaters,
posterior vitreous detachment and even extracellular matrixes which could impact the disturbance of vision and even
associated complications.
[Chi-Ting Horng, Fu-An Chen, Daih-Huang Kuo, Li-Chai Chen, Shou-Shan Yeh, Shuan-Yu Huang, and Po-Chuen
Shieh. Pharmacologic vitreolysis of vitreous floaters by 3-month pineapple supplement in Taiwan: a pilot
study. J Am Sci 2019;15(4):17-30]. ISSN 1545-1003 (print); ISSN 2375-7264 (online).
http://www.jofamericanscience.org. 3. doi:10.7537/marsjas150419.03.

Keywords：Pineapple, vitreouis floater, Bromelain

Introduction bundles, and interconnections between these bundles

The vitreous is highly hydrated gel-like structure allow the formation of an extended network that
(> 98% water) that is acellular, apart from a few cells maintains the gel state.
called hyalocytes in the vitreous cortex. Besides, the During aging, the vitreous progressively
gel state is maintained by a network of long thin liquefies and pockets of liquid form in the gel. In the
collagen fibrils that are approximate to 15 nm in adult eye, 20% of vitreous is liquid, then after the age
diameter. Filling the space is a network of hyaluronan; of 40 years there is increasing liquefaction so that by
this glycosaminoglycan (polysaccharide) may attract 80 to 90 years of age more than half of vitreous is
water and generate a swelling pressure that inflates the liquid﹝1﹞. The vitreous liquefaction, in conjunction
gel. The collagen fibrils are composed of collagen with age-related weakening of postbasal vitreo-retinal
type II, V, XI and IX. They are organised into small adhesion, then results in the posterior vitreous

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 Journal of American Science 2019;15(4) http://www.jofamericanscience.org

detachment (PVD). In clinics, the symptom of PVD is endoophalmitis, uveitis, vitreous lymphoma, and
the most common cause of acute-onset floaters. A retinal degenerations. According to past studies, the
recent paper by van Overdam and his co-workers relationship between ocular floaters and PVD was
suggested that patients with isolated PVD, vitreous close. The presence of complete PVD was highly
floaters, vitreous hemorrhages or retinal hemorrhages associated with symptomatic vitreous floaters.
at initial presentation need to be rescheduled for a Therefore, it is very important to realize the
follow up visit﹝2﹞. All peoples were instructed to pathophysiology of the vitreoretinal interface for
return if the number of floaters increases. However, knowing how to well separate and remove the vitreous
the majority of PVD is benign and physiological from the retina safely and prevent from associated
change. When the human is older than 40 years old, complications such as retinal detachment (RD) and
PVD gradually impact the visual axis. Moreover, the full-thickness macular holes (FTMHs).
prevalence of PVD is up to 24% among aged 50–59 The probability of PVD being complicated by a
years, increasing to 87% among peoples older than 80 retinal break or rhegmatogenous RD (RDD) has been
years. In PVD, the vitreous shrinks and detaches from influenced by the presence of high myopia, cataract
the retina leading to floaters. In 14% of cases, surgery, peripheral retinal degeneration, trauma,
tractional forces from the vitreous jelly over the retina previous RDD and a positive family history.
sometimes caused the retinal tears. However, left There are several high risks of the developing
untreated, the tears which result in break may allow floaters such as age > 50 years old, nearsightedness,
fluid to enter the sub-retinal space and could progress eye trauma, complications from cataract surgery, eye
to retinal detachment (RD) and even blindness. inflammation and diabetic retinopathy. Ocular floater
Therefore, early to wipe out vitreous floaters is very sometimes may accompanied with flashes which
important for eyesight preservation﹝3﹞. means the possibility of retinal tear, incomplete
Physiologically, the vitreous is a complex detachment or an adhesion of the vitreous body on the
biochemical and structural procedure. It is completely internal limiting membrane (ILM), VMA,
attached to the retina. Floaters usually begin happen vitreo-macular traction (VMT) with separation
as few small spots, curtains and clouds becoming between the vitreous and the macula, FTMHs and
much dense upon time. In most cases, vitreous resulting in retinal detachment. In addition, it
opacities occur as a result of degenerative changes. sometimes could increase the macular thickness and
The vitreous liquefaction should provoke decrease best-correct visual acuity. Therefore, this is
condensation of vitreous collagen fibers and PVD very important to differentiate from the physiological
which showed floaters. More dramatic condition is to condition for avoiding emergent floaters﹝5﹞.
induce the existence of floaters. In human, most In this study, we focused on the age-related eye
ocular floaters are small flecks of a protein called changes of the vitreous and the vitreous liquefaction
collagen in the back of your eye. As you age, the and afterwards, separation from the internal limiting
protein fibers that make up the vitreous shrink down membrane (ILM) of retina will happen and the
to little shreds that clump together. The shadows they process is mediated by the aggregation of collagen
cast on your retina are floaters. If you further see a fibrils and degeneration of extracellular matrix
flash, it’s because the vitreous has pulled away from component at the vitreo-retinal interface.
the retina. Besides, posterior uveitis or bleeding in the In optometry, floaters are the opacities in the
eye are other reasons of ocular floaters which belongs vitreous body which case shadows onto the retina.
to the serious condition of eyes﹝4﹞. At times, the The Patients see them as small moving spots or specs
symptoms of floaters may occur when these patients in the visual field. Floaters move as the eye moves,
suffering from high fever, head injuries or influenza at but do not follow eye movements precisely. When
times and the troublesome problem should recover attempted to look directly at them, the floater seem to
spontaneously after two weeks. However, after aged move away, while blinking does not get rid of them.
40, the vitreous gel should begin to liquefy involving They are mostly seen when looking at something
nearly 50% by age 80, a process called synchysis. bright like white paper, plain white or blue sky. The
When the lysis formed, posterior scaffold should floaters may appear as various shapes of lines, circle,
detach from the retina with the interventing space dots, cobwebs, clouds, and flies. In our study, one of
﹝5﹞. General speaking, the patients with monocular any shapes of retinal images was all considered as the
floaters often reflect some underlying ocular diseases. same one, and at last, we would count the numbers of
For example, the major causes of monocular floaters total floaters as the prognostic factors about the
included PVD, vitreo-macular traction (VMT) and effectiveness of pineapple treatment. Once exact
vitreous hemorrhage. Additionally, although less diagnosed, the patients complaining of floaters are
likely, monocular causes of floaters also include usually managed conservatively with reassurance the
suggestion that over the time they will adapt to the

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visual axis. fibronectin, and laminin which are the major

Traditionally there are two main management components of the vitreous strands and floaters. It
options, pars plana vitrectomy (PPV) or observation in may lead to various degrees of vitreous liquefaction
the past. The latter for stable mild disease that does and loosening of vitreoretinal attachment which would
justify the risks of surgery or in some eye with VMT decrease the development of epi-retinal membrane,
will resolve spontaneously ﹝ 6 ﹞ . Even if the VMT, and RRD ﹝ 16 ﹞ . The same idea as the
spontaneous resolution of VMT and fibril strands effectiveness of oscriplasmin about treating the
could happen, more aggressive therapies is indicated vitreous body associated overgrowth tissues﹝17﹞.
for the possibility of vision loss. Observation may The similar method may be used to cut the
have disadvantages, with a nature history study extracellular matrixes and clear the useless vitreous
reporting that only 11% of patient’s eyes showed fibrils.
spontaneous dissociation over a mean follow-up of How to use the concepts of proteinases, for
5-years, whereas 64% of eyes lost at least 2 Snellen example, trypsin, chymotrypsin, papain and some
lines over this timeframe. In addition, VMT can also hydrolytic enzymes to dissolve the vitreous strands
progress to FTMH during observation. However, the and floaters is a advanced option in the future.
patients who experience persistent or severe Bromelain is extracted from stems and fruits of the
symptomology may undergo PPV. Equally, PPV for pineapple and it contains various proteolytic enzymes
VMT may have various disadvantages, with only such as anti-inflammatory, analgesics, anti-thrombotic
one-third of eyes gaining 2 or more Snellen lines. and antifibrinolytic properties﹝18﹞. In clinic, it is
Furthermore, PPV is associated with postoperative now prescribed as the treatment of several diseases,
patients’ burden and the serious complications such as for example, osteoarthritis, dental pain and
endophthalmitis and increased intraocular pressure post-operative swelling ﹝ 19 ﹞ . During our
(IOP)﹝7﹞. Furthermore, the postoperative retinal experiences, pineapple may also be a good source of
detachment occurs in 2.4%, and 92% of phakic eyes fruit which would supply hydrolytic enzymes to
are likely to develop the cataract within 3 years of interact the vitreous contents and treat the patients
PPV﹝8 ﹞. Some newly techniques, for instance, with vitreous opacities. Pineapple ( Ananas comosus )
Nd:YAG laser vitrteolysis, pharmacolgenic vitreolysis is a delicious crown shaped fruit that grows on the
and even 25-guage vitrectomy developed﹝9﹞. For tropical plant of the same name. It is a good source of
example, Nd: YAG laser vitreolysis is commonly used a number of essential nutrients like vitamins, minerals,
in treating the vitreous opacities located near the phytonutrients, antioxidants etc. and the presence of
posterior retina. Some reports claimed that the success these nutrients make it a wonderful fruit for our health,
rates by existing publishing are highly variable, skin and hair. Pineapple is the common name of
ranging from 0% to 100% ﹝ 10 ﹞ . However, the Ananas comosus and the leading edible members of
shock from the Nd:YAG laser will use to break the the family Bromeliance, grow in the tropical and
vitreous floaters may sometime damage the human subtropical areas including Taiwan, southern China,
retina and impact the visual loss﹝11﹞. Philippines, Thailand, Indonesia, Malaysia, Kenya,
Recently, a new method of enzymatic vitreolysis and India. It has been used as a medical plant in
with intravitreal ocriplasmin (Jetrea; Thrombogenics several native culture and these medical qualities of
USA, Alcon) which is a recombinant and truncated pineapple. Its main component is a sulfhydryl protease,
form of the human serine protease plasmin. In recent with traces of acid phosphate, peroxidase inhibitors
time, ocriplasmin (microplasmin) is a potential and several low molecule weight compounds.
alternative treatment for patients with symptomatic The stems and fruits from the pineapple always
VMT and macular hole that could also remove fibril contains protease, particular bromelain, a
strands and vitreous opacity by pars plana vitrectomy non-proteolytic component which is mainly
﹝ 12 ﹞ . The ocriplasmin induced the smaller responsible for complete debridement and dissolve the
fragment of the plasminic enzyme and was approved over-growth connective tissues including several
as the first non-surgical treatment for patients with proteins and mucopolysaccharide substrates from
VMT by the Food and Drug Administration (FDA, human body ﹝ 20 ﹞ . When we analyzed the
USA) in 2012﹝13,14﹞. A total of 26.5% of subjects proliferative phase in human, this event fosters the
receiving a single intravitreal oscriplasmin (125μm) production of proangiogeic factors. Vascular
achieved the primary end point of pharmacologic endothelial growth factor (VEGF), fibroblast growth
VMA resolution at day 28 compared with 10.1% of factor 2 (FGF-2), and PDGF2 initially released by
placebo﹝15﹞. The medical effect of ocriplasmin is platelets and then by resident cells. Besides,
endothelial progenitor cells (EPCs) also plays an
enzymatically to degrade the protein scaffold in the
important role which is mediated by MMP and other
vitreo-retinal interface and cleave collagen,

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factors for matrix remodeling and even scar formation because of the complicated vitreous-retinal
﹝ 18 ﹞ . Moreover, the protease including Matrix patho-physiology.
Metalloproteinases (MMPs) would be found in the Any one shape of shadow of floater was
vitreous level in the proliferative diabetic retinopathy considered as one image. In addition, the numbers of
which could degrade the ECM and growth factors. the ocular floater was greater than one image and we
Therefore, we suggested that the autolytic, biological, concluded to the group of patients with multiple
and enzymatic which would be used in the biological floaters. The peoples with patients were excluded if
activities bromelain in removing vitreous constitutes the signs from the examinations were not apparent
and its floaters﹝21﹞. when they subjectively suffered. The persistence of
In this study, we will evaluate the effectiveness vitreous floaters from the patients’ description and the
of pineapple plant to treat the patients with ocular object findings (focal echodensities) from the B-scan
floaters and some VTMs for the restoration of visual ultrasonography and ophthalmoscopy were all
axis and even recovery from the baseline. confirmed together. Indeed, the ultrasonography
provides rea-time imaging of internal and peripheral
Methods and Materials vitreous structure. Besides, it expands the evaluation
This institutional review board (IRB) approved of the patients with floaters﹝24﹞. When subject
retrospective study included 388 consecutive eyes of complaints and the exact diagnosis was consistent, the
388 patients complained about floaters on the subject should be enrolled in the study. All 288
southern Taiwan. This study followed the tents of the participants were divided by the numbers of ocular
Declaration of Helsinki. Moreover, patients were floaters to one or multiple (> 1). Therefore, the
included if they were at least 18 years of age and did patients were all asked to take various pieces of the
not suffered from the ocular floaters after trauma or pineapples and the time of study endpoint time was
major disorders within 6 months. The reason is that three months. After they began to eat the pieces of
some medical reports demonstrated that the quick pineapples which were prepared by our medical staffs,
liquefaction occurred, and the inner contents should the patients returned for series of examinations of
result in change after trauma or other disorders. check-up every month. All the crude pineapples were
Interestingly, in experiment 1, when these ocular from southern Taiwan including Pingtung, Kaohsiung
images of high conscious subjects mentioned at least 1 and Tainan and cut open to several pieces (Fig. 1).
image interpreters, the diagnosis of vitreous opacities, After weighting, every piece of the pineapple was
PVD and some symptomatic SMV subjects were mean 100 gram. All 388 patients will take the pieces
confirmed by indirect ophthalmoscopy, B-San of pineapple according to various designs. The 190
(ultra-sonography) and spectral domain optical and 199 subjects were enrolled in experiment 1 and 2
coherence tomography (SD-OCT) of all participants randomly. At first (experiment 1), 190 patients were
﹝22﹞. Ultrasonography is routine used to diagnosis separated to 2 subgroups: one floater and multiple
PVD and vitreous floaters, because of their characters floaters ( > 1) in experiment 1. Secondarily
of dense collage matrix. Besides, OCTs allow detailed (experiment 2), 199 subjects with one or multiple
imaging of the transverse and coronal aspects of the floaters would be divided into 3 subgroups randomly
vitreoretinal interface. It may also easily and clearly and they received various (low, middle, high)
detect the vitreous floaters. Therefore, a dilated treatment in the experiment 2. When the numbers
examination of the ocular fundus is mandatory. decreased, the positive findings were confirmed as
Therefore, only patients with stable and solid vitreous successful therapy. Afterwards, we compared the
opacity and PVD were enrolled in our experiment. results of the pineapples to the treating the ocular
However, the floaters form the blood clots or floaters in the experiment 1 & 2 before and after 3
unexpected incomplete PVD were all excluded in our months.
experiments﹝23﹞. Besides, all the systemic diseases; There was sdualed between 2016 March with
hypertension, DM, hyperglycemia and connective June in 2016 for heidig the “bright: survey about the
tissue disorders may impact the normal physiological concent for treating ocular flater which is an incurable
PVD. Moreover, age, and lens status showed disease in the past decaded. All 388 participants were
significantly positive impact on floaters. Moreover, arrangged to undergo underwent series of ocular
the vitreous hemorrhage in proliferative retinopathies examinationss. The whole study was done omletely
including diabetic retinopathy, sickle cells, venous whole-3-month and we compared with the
occlusion, Eales disease, intraocular inflammation, ourtomecomes after 3-month supplement. In fact, the
trauma surgery, and asterosis hylosis as well as bromelain is obtained from the stem or fruit of the
myopia (high myopia > 8D). The above were pineapple. It is sold in the form of a powder, cream,
excluded from our study excluded from our study tablet, and capsule. In our study, we directly cut the
whole pineapple into several pieces horizontally

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which each piece pineapple may contain stems and inflammation were observed. Besides, the intraocular
fruits. In experiment 1, the 190 participates were pressure and blood sugar of all participants was
separated to one floater (group 1) and multiple floaters normal. All the vision of the participant remained
(group 2), Hence, all the 190 subjects were asked to stable and the angle of chamber, lens status corneal
eat 2 pieces of pineapples prepared by our staffs every and zonular fibers all showed normal by mean of slit
day. In the experiment 2, 198 patients with 198 eyes lamp (SL-D7; NIDEK) and anterior segment OCT
would be considered to 3 subgroups: low pineapple (Heidelberg OCT)﹝25﹞.。
group (LPA)，middle pineapple group (MPA) and Furthermore, no participants suffered for any
high pineapple group (HPA) for various pieces of the discomfort and side effects from the pineapple
designed supplement. Taking too many pineapples is supplement. The definition of the case “succeed” is
harmful to DM patients which may elevate the that the floaters and retinal shadows were no longer
glucose level in the blood and the maximal amount of visible by the indirect ophthalmoscopy and even
the pineapple in our experiment is to eat 3 piece SD-OCT detection. Beside, some of the participants
(about 300 g) each day which is safe. Therefore, we would tell us that they could see the scene beautiful
designed for 2 pieces of pineapples (around 200 without black image blacking after 3 months.
mg/day) for the management strategies for everybody In experiment 1 (2 pieces /day for every one), the
in experiment 1. Besides, in experiment 2, all 199 percentage of 120 patients with one floater
patients were divided to 3 subgroups and their successfully disappeared to only 35 subjects (29.2%;
received various doses treatment. The low-, middle-, 35 /120) (P < 0.05). Besides, 70 patients with multiple
and high-dose pineapples (LDP, MDP, HDP; 1, 2, 3 floaters decreased to only 19 patients (27.2%; 19 /70)
pieces, respectively) were given. Afterwards, we with regular supplement of pineapples for 3 months (P
compared the outcomes of the pineapples to the < 0.05) (Table 1).
treating the ocular floaters after 3 –month treatment. In experiment 2, the final results of various
In experiment 1 and 2, the participants all took the floaters in 3 groups with LPA, MPA, and HPA
pineapple after the launch. Besides, all subjects were treatment were compared after they took different
arranged to return to receive series of exanimations doses of the pineapple for 3 months. Firstly, we found
and follow the ocular condition every month. that 66 patients with LPA treatment taking one piece
All patient charts were reviewed for age, sex, of pineapple every day in subgroup 1 decreased to 33
lens status, chief complaint, the numbers of ocular subjects (45.5%; 30/66) after 3 months (P < 0.05).
floaters, any discomfort and side effects from the Secondarily, 66 participants with MPA treatment
patients. Besides, all data were measured and the taking two pieces of pineapple every day in subgroup
statistically differences were measured for the effect 2 significantly changed to 22 subjects complaining
of pineapples with use of SAS 9.0 (SAS Inst., Cary, about decreased shadow of retinal image (33.3%;
NC, USA). The P value < 0.05 was considered 25/66) after the whole 3-month-peroid therapy (P <
statistically significant. 0.05). In subgroup 3, 66 patients were asked to take 3
pieces of pineapples each day. Three months later, the
patients with lower floaters dramatically changed to
17 patients (25.8%; 17/66). During series of
examinations, we found the vitreous opacity had
absorbed without further blocking the visual axis
(Table 2). Furthermore, it is reported that the greater
amounts of pineapples intake, the lesser patients
remained the vitreous opacities and floaters.
According to the maximal doses of pineapple
supplement, the more effectiveness in treating floaters
and enhancing the vitreous opacity showed lysis. In
summary, treating the patients with ocular floaters by
pineapple supplements revealed the dose-dependent
manner. It is interesting to find that the patients with
Fig. 1. The pineapple is abundant in Taiwan.In our floaters during a 3-month-peroid therapy were 45.5%,
study, the whole pineapple would be divided into 33.3% and 25.8% and 1, 2, 3 pieces of pineapple,
several pieces which may be used to treat the patients respectively. We concluded that pineapples intake
with ocular floaters. may decrease the aggregation of collagens fibrils
forming fibers and the rates of symptomatic floaters.
Results Furthermore, we suggested that bromelain is
In the whole study, no retinal damage or ocular advantageous over the frim PVD easily separated

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from the vitreo-retinal interface. Therefore, pineapple floaters.

supplement is good for the patients with various

Table 1: The change of various floaters before and after eating over a period of 3 months
Ocular floater numbers Before 1st month 2rd month 3th month
One 120 119 88 35* (29.2%)
Multiple 70 68 52 19* (27.1%)
N= 190 eyes
1. Multiple floaters means that the patient with at least 2 floaters.
2. After treatment, the patients with multiple floaters may complete or incomplete disappear. Therefore, the multiple
floaters would change into 1 or 0 floaters.
*3. We compared with the results at the basal time and 3 months by ANOVA. If p value is less than 0.05, it showed
significant differently.

Table 2: The change of ocular floaters before and after taking pineapples over a period of 3 months
Numbers of pineapple Before 1st month 2rd month 3th month
1 pieces 66 66 54 30* (45.5%)
2 pieces 66 66 56 22* (33.3%)
3 pieces 66 60 58 17* (25.8% )
1. Group 1 (N= 66 eyes): the patients took 1 piece of the pineapples
Group 2 (N= 66 eyes): the patients took 2 pieces of the pineapples
Group 3 (N= 66 eye): the patients took 3 piece of the pineapples
*2. We compared with the results at the basal time and 3 months by ANOVA. If the p value is less 0.05, it
showedsignificant differently.

Disscusion cross-link, which stabilize the collagens fibrils.

Vitreous is a dilute meshwork of collagen fibrils Hydroxylysines also provides potential sites for
interspersed with extensive arrays of hyaluronan postslational glycosylasines. To date, nearly 30
molecules. Besides, hyaluronan is the major different types of collagens molecules for more than
macromolecules of vitreous which is a, unbranched 40 genes have been characterized. Interestingly,
polymer of repeated disaccharides linked by vitreous collagens resemble collagens fibrils.
glycosidic bonds in Physiology. Moreover, hyaluronin The onset of floaters is often secondary to PVD
is also covalently to a protein core; the ensemble is and the possible complications. When the patients
called proteoglycan. From further analysis, vitreous complained about floaters, they should be referred to
contains collagen type II, a hybrid of type V/XI, and special ophalmologists for detailed examination to
IX collagen in a molar ratio of 75: 10, 15, respectively. exclude the more peripheral region of retinal tear or
The Vitreous collagens are organized into fibrils, with detachment. Moreover, the physicians should identify
type V/Xi residing in the core, type II collagen the possible “vitreous floaters’ as urgent approach.
surrounding the core, and the IX collagen on the According to previous studies, acute onset of floaters
surface of the fibrils. and even PVD would develop into the retinal break
In anatomy, vitreous consists of hepatocytes, within six weeks. However, early diagnosis and
collagens (type I, IX, V/XI and VI collegens), GAGs, possible treatment for the floaters and PVD becomes
PGs, and other extracellualr matrix molecules very serious.
(fibrillin. Optcin, VIT-1). The collagen molecules are The nature and composition of the vitreous
coiled by three α polypetide chains coiled into humour changes over the course of life. In
left-hand helix. The three chains are then warps adolescence, the vitreous cortex becomes more dense
around each other to a right amino acid is a and vitreous tracts develop; and in adulthood, the
glycine-residual that creates Glycine-X-Yn amino tracts become better defined and sinuous. Central
acid repeat. The X-and Y-repeats can be any amino vitreous liquefies, fibrillar degeneration occurs, and
acid, but often X is alanine or proline, and the Y is at the tracts break up. The coarse strands develop with
times hydroxyproline. Besides collagens, are also rich ageing. The gel decreases with age, and the liquid
in lysine. All collagens have non-triple-helical region volume increases. Cortex may disappear at sites,
bonds and stabilizes the structure of the collagen triple. leading to liquid vitreous extruding into the potential
hydroxoxyproline forms hydrogens bonds and space between vitreous cortex and retina. Therefore,
stabilized. The lysine and hydroxylysine residues are vitreous floaters may be the symptoms or signs from
necessary for the flotation of intramoculecular peoples which is leading to the ghosts of blindness by

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the side﹝26﹞. A follow-up visit for patients with an ﹝31﹞. Wagle and his co-workers reported that these
isolated PVD or floaters can be justified to detect the patients with floaters and PVD were willing to take an
small percentage of asymptomatic retinal breaks. 11% risk of death and a 7% of blindness just to get rid
Vitreous opacities may affect patients at any age of the bothersome floaters due to impairment of
whereby you experience eye floaters. Most of the driving ﹝ 30 ﹞ . Therefore, how to decrease the
floaters are small spots that drift through the field of numbers of vitreous floaters becomes the importance
human vision. Moreover, they may stand out when issue. Besides, they also raise the demand for
you look at something bright, like white paper or a healthcare for the ophthalmic professionals and extend
blue sky. Visual floaters are visual phenomena caused the range of their service provision﹝32﹞.
by degenerative changes of the vitreous gel. Over time, The vitreous liquefaction which destabilizes
the vitreous collagen type IX decreases, resulting in collagen fibrils at age 4 years and 12,5% of the
the surface exposure of “sticky” type II collagen. vitreous is liquefied at age of 18. The most common
Hence, these result in the vitreous collagen fibrils to etiologic cause of floaters is age-related and
aggregate and liquefy, and accompanied vitreous myopia-induced liquefaction of the vitreous gel. It is
shrinkage and clumping make tiny shadows on the to find that liquefaction induces collagen into visible
retina﹝27﹞. The PVD entailed the collapse of the fibrils and leads to collapse of the vitreous body.
vitreous body and anterior displacement of the According to further research, the most
posterior vitreous cortex and is the most common macromolecules in vitreous are collagens II and
cause of floater. The symptoms might annoy some collagens IX, glycosaminoglycans (GAGs) which like
peoples and shouldn’t interfere with the eyesight. hyalluronic acids (hyaluronan; HA), proteoglycan
However, the floaters sometimes may impair the (PGs) and non-collagenous glyco-proteins. Because
ability to read, use the computer and smartphone, and the characters of water may bind to HA, the ageing
drive. The impact is more challenging for some high process would lead to two structural changes: (1).
detail visual requirements, particularly in dynamic depolymerization of HA which cause release of water
setting, for instance performing music from sheet structural changes (2). loss of collagens IX which
music. It even appears in the peripheral vision, giving provokes aggregation of collagens II fibrils and
the sensation of peoples approaching from behind or further leads to formation of fluid filled with lacunae.
from the side. Efforts to temporarily alleviate visual Therefore, collagen filaments aggregation and
interference include eye blinking, rubbing eyes, condensation resulted in formation of larger fibrils,
closing one eye or moving the head. These maneuvers which would float in lacunas of liquefied vitreous
only give short windows of visual clarity. Vitreous giving the patients the perception of floaters. The
floater symptoms usually subside with passage of time; speed at which these vitreous changes happen depend
however, some patients with floaters may suffer from on the people’s age, environmental factors, exposure
persisting discomfort, psychological distress and seek to sunlight, oxidative stress, and HA-collagen
medical care. Hence, the constant struggle to achieve interaction. As for age, patients > 70 years old, we
adequate visual transparency for some peoples comes could find that at least 50 % of the vitreous is
to impact their emotional and physical resilience as liquefied. In summary, the floaters did not impact the
well ﹝ 28 ﹞ . Interference of the floaters with the human visual acuity; and the numbers are sometime
visual axis would result in patients’ discomfort. increase with age.
Besides, the contrast sensitivity may decrease to 67% In young ages, the vitreous is a clear gel that fills
starlight increase in eyes which would induce the the vitreous cavity, occupying approximately 80
unhappy mood ﹝29﹞. Recently studies indicated percent of the volume of the globe, so called “ myopic
that vitreous floaters can have a significant negative vitreopathy”. In nature, the vitreous consists mostly of
impact on visual function and in turn the quality of water (99 %) as well as hyaluronic acid and a
life﹝30﹞. Although in most patients the floaters are meshwork of fine collagen fibrils. An important area
minimal, they can cause various significant is the vitreous base, a 3- to 4-mm-wide
impairment in vision-related quality of life in a small circumferential zone of vitreous that straddles the ora
population of patients. Now, a new definition of serrata. In the vitreous base, the collagen fibers are
floaters as “symptomatic vitreous opacities (SVO)” firmly attached to the underlying peripheral retina
was further made. Ivanosva et al. summarise that the posterior to the ora serrata and to the pars plana
SVO also could lead to intermittent blurred vision, epithelium anteriorly. Other areas of firm vitreous
glare and even haze attributable to migration of attachment are at the edges of retinal scars, in areas of
vitreous opacities into the visual axis. This event lattice and other vitreoretinal degenerations, at the
interferes with many important activities of daily life optic disc, and along the major vascular arcades. The
such as reading, driving, and performing near work prevalence of PVD increases with age, with axial

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 Journal of American Science 2019;15(4) http://www.jofamericanscience.org

length, and following cataract surgery and trauma. As the timing of operation, In Japan, most of the
Vitreous floaters would be a part of the PVD in clinic. vitreo-surgeons favored that the time of emergent
According to other articles, it is demonstrated that operation until observation when the patients’
myopic peoples should experience floaters and PVD best-corrected visual acuity dropped to 6/30﹝12﹞.
approximately 10 years earlier than those with Patients with vitreous floaters and mild PVD
emmetropia or hyperopia. Besides, human lens could receive closely follow-up. Although almost all
removal allows hyaluronic acid to diffuse more easily patients accept the conservative management option,
out of vitreous into the anterior chamber and there is a small subset of patients who may desire a
subsequently out of the eye. Then, the unsupported more aggressive treatment intervention for resolution
collagen fibers then collapse together. Indeed, the of their visual symptoms﹝21﹞. However, they does
posterior capsule may induce an effective barrier to not spontaneously release, aggressive treatment
hyaluronic acid, and the procedure of posterior including surgery should be taken into consideration.
capsulotomy may enhance floaters and possible PVD For example, vitrectomy is indicated for the common
easily. This event occurs as a result of liquefaction. choice. Till today, various methods were arranged to
With increasing age, an opening ultimately develops treat the vitreous floaters, complete or incomplete
in the posterior vitreous through which the central PVD, and symptomatic VMT. Vitreous floaters are a
liquefied vitreous passes suddenly into the common complaint in the ophthalmic care setting.
retro-vitreal space, rapidly dissecting a plane and However, most of the condition is benign, ophthalmic
separating the posterior hyaloid from the retina. care practitioners have little to offer regarding
Furthermore, floaters and PVD is involved as inciting treatment options. The majority of cases encountered
event in most cases of RRD ﹝ 33 ﹞ . Typical are managed with patient education and reassurance.
symptoms of PVD are floaters which are described as Now, there are several therapies in solving the above
cobwebs, spots or hair in the field of vision, and they vitreous problems including vitrectomy, pneumatic
are caused by vitreous opacities, for instance, the vitreolysis, Nd: YAG laser vitreolysis, and
epipapillary glial tissues torn from the optic disc, pharmacologic vitreolysis﹝34﹞.
condensations of vitreous collagen, and/or blood. Pars plana vitrectomy is an effective treatment to
However, acute symptomatic retinal breaks resulting surgical removal of the vitreous opacities, incomplete
from severe PVD have a high risk of RD with visual fibril strands, firm VMA, symptomatic VMT and even
loss. Moreover, incomplete PVD may also induce the FTMHs until 1991. Some surgeon even made use of
formation of VTM. If it left untreated, partial VTM the gas tamponade (SF6 or C3F8) for as long as
may improve through spontaneous resolution, and possible in an attempt to enhance closure rates. Kelly
however, some patients unfortunately developed into and Wendel postulated that vitrectomy would removal
deterioration in their vision. Therefore, removal of traction around the hole and this, combined with gas
vitreous floater becomes the mainstay treatment in tamponade, would result in the ring of perifoveal
unexpected development of ocular diseases. detachment flattening with some (58%) improvement
Current treatment options for vitreous opacity, their vision﹝35﹞. There is a relationship between
PVD, and symptomatic VMT in patients included the these two choices- gas choice and postsurgical
observation, pneumatic vitreolysis, Nd: YAG laser requirement--- that related to the amount of time of
vitreolysis, pars plana vitrectomy and nearly time that gas still bridges the severe VMT or holes.
developing pharmacologic vitreolysis. At first, close The combined gas (air-fluid exchange) could cross the
observation by the experienced ophthalmologists at defect of a macular hole without face-down
regular time indicated when the victims if relative positioning down in an upright position if the gas fill
young or too old to clean by for the old peoples with exceeds 50%, an long-acting tamponade will maintain
limited vision. Indeed only close follow-up is >50% gas till for a long time than air or short-acting
certainly a reasonable initial approach, as the progress gases. Unfortunately, vitrectomy could also carry
of VMT is known to spontaneously release in some significant surgical risks, including cataract, glaucoma
patients. Therefore, early to preserve the human body and RD which may limit the broad indication of
and even ophthalmic acuity is very important. The
vitrectomy for floaters﹝36﹞.
VMA always developed when the traction forces
As for the method of pneumatic vitreolysis
exerted on the area of adhesion which are sufficient to
(PVL), the small quantity of expansible gas was
produce anatomical distortion of the macula, resulting
injection into the vitreous cavity for achieving focal
in severe VMT and even FTMHs formation. The
VMT release for eyes with symptomatic VMT. The
symptoms and signs of patients with VTM and
method of pneumatic vitreolysis is the intravitreal
FTMHs included ocular floaters such as
injection of a small quantity of expansible gas for the
meta-morphopsia, visual acuity changes, lower the
purpose of achieving focal VMT release for eyes with
contrast sensitivity and central visual fields defects.

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 Journal of American Science 2019;15(4) http://www.jofamericanscience.org

floaters, VMT, or inducing VMT release and closure vitreoretinal interface facilitates release of VMT in
of macular defect since 1993. The success rates of some patients and must simultaneously liquefy the gel
VMT release have ranged from 60% to 100% and the liquid and weakening the VMA. A randomized,
rates of closure of small macular holes have ranged controlled trial (called MIVI-TRUST) examined the
from 50% to 80% following PVL which is a use of ocriplasmin for pharmacologic treatment of
promising, low-cost therapeutic option, with the VMT in 652 eyes. Therefore, Stalmans et al reported
potential for managing symptomatic VMT and that the success of traction release was achieved in
vitreous floaters on a global scale. The intravitreal 26.5% at day 28, significantly compared with only
special gas (i.e.: C3F8) bubble creates an intragenic 10.1% in the control group. The vitreous floaters and
PVD that relieves VMT in some patients. However, VMT is the pathologic consequence of vitreous
the success rates of VMT release ranged broadly. attachment with structure disturbance of retina which
Besides, the danger of intravitreal injection including would be dissolved by ocriplasmin successfully
intragenic cataract, glaucoma, endopththalmitis, ﹝22﹞. Grandorf et al. reported that dose- and time-
retinal breaks, and the development of RD﹝37﹞. dependent cleavage by ocriplasmin between posterior
Nd: YAG laser vitreolysis is attractive because it vitreous cortex and the ILM in both human cadaver
is relative simple and effective for treating the mid-, and feline eyes﹝38﹞. Recently, oscriosplamin is
posterior floaters and even Weiss ring floater﹝38﹞. even considered as the cost-effective in patients
The mechanism of laser vitreolysis would be used to without epi-retinal membrane or full thickness
the lysis of fibers and rhexis of aggregates, followed macular hole which is useless to utilize vitreolysis and
by displacement out of the visual axis which could be absorbing the extracellular matrix and proliferative
offered to treat symptomatic vitreous floaters. tissues such as vitreous floaters (so called vitreous
Recently, this method has been widely used to balls).
collagenous vitreous strands, tranvitreaval sheets or The reason for sudden onsets in patients 50 years
bands, and mostly to break the vitreous opacities. This or older has been related to PVD in 95% cases.
is generally performed by focusing the laser onto the Furthermore, in the pathoghenesis of PVD, after
vitreous opacities visible at the slit-lamp. Typically, vitreous liquid liquefaction, the second most
only opacities relatively far from the retina are treated, important event is the age-related weakening of the
thus these represent a subset of floaters that might be adhesions between posterior hyaloid membrane and
appropriate to treat with Nd:YAG laser. Unlikely the internal limiting membrane, which leads to
vitrectomy, the laser is closed eye obviating the risk of separation of these two structure, shrinking and
endophthalmitis, rapid progression of cataracts, collapse of the vitreous body )﹝39﹞. In patients with
elevated intraocular pressure leading to glaucoma, high myopia, vitreous liquefaction, floater liquefation
posterior capsule defects, retinal tear or hemorrhage occurred floaters related PVD occur much earlier
and even severe RD. However, this non-aggressive compared to the same age patients, with emmetropia
alternative method is more dedicated and safe than or hyperopia﹝40﹞. Early vitreous liquefaction and
vitrectomy. Therefore, amorphous floaters in the mid- PVD has described ion conditions following trauma,
to posterior vitreous are clinically significant and phakia, intraocular inflammation, vitreous hemorrhage
difficult to visualize and treat by Nd:YAG laser. and retinal venous diseases﹝41﹞. During ageing, the
Medical therapeutic evolve from surgery to vitreous degenerates by times, collapses and detaches
pharmacotherapy and then to prevention as a result of from the retina which may induce the complete or
increased knowledge about the origin and incomplete PVD. The most common complications of
pathophysiology of diseases. The treatment of age-related total PVD, are retinal tear, vitreous, retinal,
vitreo-retinal diseases is currently undergoing the first and optic-disc hemorrhage as well as RDD.
stage of this paradigm shift with development of Because the association between vitreous
pharmacologic vitreolysis. Hence, the concepts of floaters and PVD is very close, it is very important to
proteolytic and collagenotic enzymes to attempt to realize the epidemiology. In patients with acute onset
remove and dissolve of burn or traumatic eschar and of floaters as a consequence of PVD, the incidence of
proliferative tissues for years. It is interesting to find the retinal tear 14.5 % and that of vitreous and/or
that the stem of the pineapple plants also contains a retinal hemorrhage was 22.7%﹝42﹞. Besides, visual
number of protease (particular bromelain) and
impairment was found to be a predictor for retinal
non-proteolytic component enzymes (for the complete
pathology, which is in accordance with previous
debridement of burn). Current option showed that the
studies where 67% of patients with decreased visual
decreased vitreous cells and proliferative tissues.
acuity had retinal tears or detachments whereas 19%
Therefore, intravitreal injection with Ocripplasmin is
of patients with floaters or flashes alone had these
a potential alternative therapy for floaters, and VMT.
conditions﹝22﹞. A previous study showed floaters
The enzymatic activity of ocriplasmin at the

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 Journal of American Science 2019;15(4) http://www.jofamericanscience.org

in 42%, flashes in 18%, and both floaters and flashes cataract surgery were noted. Furthermore, the
in 20% of PVD and secondary retinal pathology. The incidence of RD with post-operative PVD after
incidence of retinal rupture increased from 4%–5% uneventful for phacoemulsification was 21.2 %. The
with only floaters to 10%–11% with flashes onset of postoperative PVD should be considered an
with/without floaters. However, floaters alone should important risk factor for the development of RD after
not be discarded as unimportant; It is found that cataract surgery, particularly in eyes with lattice areas.
26.7% of the retinal tears or RD occurred with floaters We collected all the results and concluded that
alone. It has been shown that PVD usually occurs in patients with vitreous floaters or any fibrils strands
the other eye within 6 months to 2 years after the first should arrange series of management according to the
eye.19 It is likely that PVD is a parallel process in amounts and location of the “trouble” vitreous
both eyes and thus the patient should be informed of opacities﹝45﹞.
possible pathologies not only in the eye with the In the past, observation is a negative concept
present pathology but also in the other eye as well. because of the advanced vitrectomy techniques which
Hence, the presence of a retinal tear should promote could easily remove vitreous collagen and hyaluron
special attention to the retinal status of such a patient with smaller instruments. Current surgical techniques
in the future. Therefore, we had better approach the are sutureless because highly shelved small gauge
floaters when they happened even though some of scleromies are self-sealing, obviating the need for
them were indicated for waiting. sutures. Aspiration setting and cut rates are the same
Besides, patients with uncomplicated PVD as typically used for vitrectomy, that is, between 400
which have a 3.4% chance of retinal tear within 6 and 600 aspiration and 1800 to 2500 cut per minute.
weeks rapidly. However, could reveal floater show for The amount of vitreous removed varies from
prevention from DR and permanent vision loss if left extensive with surgical induction of PVD, to limited
untreated ﹝ 42 ﹞ . Hence, early to quantify the without PVD induction and with preservation of 3 to 4
association between relevant clinical variables and mm of retrolental vitreous. The preservation of
risk of retinal tear in patients presenting with retrolental vitreous is thought by some to mitigate
acute-onset floaters and its treatment become very cataract formation post-op. In addition, the amount of
important. According to the Byer’s study, the prompt vitreous removed determines how much balanced salt
and conscientious vitreo-retinal examination of each solution is infused, varying from more than 10-15 ml
patient older than 45 years of age who experiences in extensive vitrectomiest around 5 ml for limited
vitreous floater, it is the most effective way for vitrectomies. Future further enhanced control over
preventing RRD. Of 163 patients who had one to two how much and which pats of the vitreous body are
floaters as their presenting symptom, with or without removed﹝46﹞. Although survey results showed the
light flashes, the retinal tear should develop in 7.3% percentage satisfied ranged from 85% to 100% of
of total patients. Therefore, Byre had concluded that participants, most of the peoples prefer food or
in this early floaters stage when the symptom was nutrition supplement for treating floaters than
detectable, it is crucial in terms of providing an operation﹝47﹞.
opportunity for early treatment of vitreous floater that There are many uses in pineapple and its derived
might prevent RD formation ﹝43 ﹞. Furthermore, ingredients. Along with papain, bromelain is one of
Dayan and his colleagues also reported that retinal the most popular proteases to use for cooking meat.
tear may be found in 26.7% of patients with PVD The potential medical uses of the bromelain maybe
presenting with floaters alone. In their study, 295 due to its proteases. However, bromelain has not been
patients with floaters were reviewed. 64% had only scientifically proven to be effective in treating any
isolated PVD (the most common), 16.6% had DR and diseases and has not been approved by the U.S. Food
31% had flat retinal tear. They further commented that and Drug Administration for the treatment of any
floaters were as predictors of vitreo-retinal pathology disorder. In USA, the passage of the Dietary Supple-
﹝26﹞. As Sharma and his co-workers, they found ment Health and Education Act allows the sale of
that vitreous floaters is the presenting symptoms of bromelain-containing dietary supplements, even
patients with PVD-related cases, flashes in 62% and though efficacy has not been confirmed. However,
both 51% cases within duration of less than 1 month bromelain could be used as a known allergen.
﹝44﹞. Now, due to the overuse of computers and Currently, bromelain is used as a dietary supplement
smartphone, the case of condition of pre-mature for nasal swelling, inflammation, osteoarthritis, poor
cataracts, PVD and vitreous floater were increasing. digestion, osteoarthritis (Knee), increased heart rate,
PVD is even more accelerated after cataract surgery adjusting menstrual problems, cardiovascular disease,
and 75.8 % eyes without preoperative PVD or lattice burn, wound care, pain control, antithrombotic,
degeneration showed a higher incidence of RD after anti-inflammatory, various anti-cancer effects,

26
 Journal of American Science 2019;15(4) http://www.jofamericanscience.org

acute rhinosinusitis, preventing pulmonary edema, been harvested﹝57,58﹞. According to classifications

stimulating contraction, slowing the clotting system, (E.C number): bromelain may be separated into 2
improving the absorption of antibiotics, preventing major extract components including stem bromelain
cancer, reducing labor, and assisting the body (EC 3.4.22.32) and fruit bromelain (EC 3.4.22.33).
eliminate fat, improving antibiotic absorption, However, stem-bromelain is distinguished from
minimizing the muscle soreness after intense exercise, fruit-bromelain, previous called bromelain. These 2
relieving pain related to arthritis and knee concern, enzyme number is not the same and, in other word,
gout, bruises, ulcerative colitis, tendonitis, carpal various biochemistry activities should be different in
tunnel syndrome and inhibiting the ability of usage. Produced mainly in parts of the world where
colorectal cancer [48,49,50,51,52,53,54] . Moreover, pineapples are grown, such as Thailand, Malaysia and
bromelain is also claimed as a tooth plaque removal Taiwan. Bromelain is extracted from the peel, stem,
enhancer in toothpastes. Furthermore, systemic en- leaves or waste of the pineapple plant after processing
zyme therapy consisting of combinations of prote- the fruit for juice or other purposes. The starting mate-
olytic enzymes such as bromelain, trypsin, chy- rial is blended and pressed through a filter to obtain
motrypsin, and papain were also prescribed. However, a supernatant liquid containing the soluble bromelain
some of the peoples may induce allergic reactions to enzyme. Further processing includes purification and
pineapples and we would pay attention to the concentration of the enzyme.
phenomena. Fortunately, there were no special Vitreous may maintain the transparency for
side-effects or discomfort in our treatment with maximal photon transmission to the retina. Besides,
pineapples. vitreous may also maintain lens transparency by
Plant proteases have essential role in many mitigating the effects of reactive oxygen species on
regulatory processes associated with events in tissue lens proteins and thus preventing from cataracts. This
growth and environmental change. In addition, the antioxidant effect is primarily the result of high
proteases are important in response to various stress concentrations of ascorbate in vitreous, an observation
such as wounding or proliferative phase. For example, originally made in 1944 by Friedenwald and
the new protease “Anti-acanthin” was isolated from colleagues. Therefore, another pathway to dissolve the
the “Bromeliaceae” which may be used to dissolve the vitreous opacities may be by the theory of reactive
proliferative fibrils in vitreous﹝55﹞. The cystein oxygenase species (ROS) which is very popular in
protease are the most abundant in Bromeliaeceae many studies. For example, Yeh et al. found that ROS
including papain, bromelain and ficin ﹝ 56 ﹞ . In levels were significantly elevated in the vitreous fluid
eclectic microscopy, we could easily found that of proliferative diabetic retinopathy (PDR) patients,
insoluble fibrils could be de-polymerized to a soluble and patients with a more advanced clinical PDR
form by several proteolytic enzymes such as pepsin appearance had higher ROS levels. Moreover, the
and ficin. Furthermore, the swollen fibrils should be ROS theories and oxidative stress might be correlated
found after digestion by pyrolytic enzymes. The above with PDR severity ﹝ 59 ﹞ . Besides, Akiba
evidence should be used to explain why the patients demonstrated that ROS may contribute to vitreous
taking pineapples may decrease their vitreous floaters. liquefaction which is a part of the normal ocular aging
In fact, pineapples have a long tradition as a medicinal process and associated with vitreoretinal pathology. It
plant among the natives of South and Central America. is found that the hyaluronic acid, one of the main
Isolation of bromelain was recorded by the components of vitreous gel, could be degraded by
Venezuelan chemist Vicente Marcano in 1891 by ROS including free radicals. It is believed that the
fermenting the fruit of pineapple. In 1892, some structural changes in vitreous may be caused by ROS
authors investigated the matters more completely, and ﹝ 60 ﹞ . Upon inflammation, the vitreous gel
called it 'bromelin'. Later, the term 'bromelain' was contracted and released a water-like liquid. In addition,
introduced and originally applied to any protease from superoxide dismutase can suppress the liquefaction,
the plant family Bromeliaceae. Bromelain from the the destruction of the vitreous gel structure resulted
pineapple is a mixture of protein-digesting from ROS generated from inflammatory cells.
(proteolytic) enzymes and several other substances in Although many unknown factors contribute to
smaller quantities. Moreover, the proteolytic enzymes vitreous liquefaction, ROS may be the main cause of
are sulfhydryl proteases; a free sulfhydryl group of a vitreous structure alterations. Recently, Bromelain
cysteineamino acidside chain is required for function. was found to have anticancer effects and the
Now several researchers all found that bromelain is mechanisms were explored by assessing the role in
present in parts of the pineapple plant, but the stem is inducing ROS, superoxide, autophagosomes, and
the most common commercial source, because usable lysosomes. Therefore, the abilities to lower the higher
quantities are readily extractable after the fruit has levels of ROS in pineapple were considered as the

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 Journal of American Science 2019;15(4) http://www.jofamericanscience.org

possible mechanisms of treating vitreous floaters by problems. Besides, we will further find out the exact
the effectiveness of bromelain﹝62﹞. Müller and his biochemical properties and the real pathway in
ci-workers also found that bromelain are cysteine dissolving the vitreous floaters.
proteases from pineapple, are known to have the
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