Enzimatic Vitreolysis: Surgical Findings in Unsuccessful Cases


EDITED FILM


ABSTRACT

Introduction:

Pharmacologic vitreolysis with ocriplasmin is an effective nonsurgical treatment option for vitreomacular traction (VMT). Ocriplasmin is a truncated plasmin derivative approved as an intravitreal drug for release of focal vitreomacular tractions (<1500 μm), when accompanied by visual symptoms, and/ or closure of macular holes (MH) <400 μm. Although few complications have been reported, a few authors state on the unpredictability of the results of this treatment. The MIVI-TRUST study report ed release of VMT in 26,5% of cases and MH closure in 40.6%. Following commercial availability of ocriplasmin, several clinical series have been published which offer “real-world” clinical outcomes with pharmacologic vitreolysis and provide additional insights regarding patient selection. Causes for failure remain to be understood and we seek to find answers. The authors present their experience with ocriplasmin and surgical findings in cases of failure.

Methods:

We reviewed all cases injected with Jetrea® over the last 2 years, and surgical outcomes of patients submitted to vitrectomy after unsuccessful therapy.

Results:

We injected ocriplasmin in 16 eyes of 15 patients with VMT, 3 of which had a medium MH and 1 a small MH. We achieved VMT release in 7 patients (43,75%), but no MH closure. 6 cases of VMT and all MH cases were vitrectomized. All cases had similar surgical findings: an anomalous and incomplete posterior vitreous detachment, multiple layers of vitreous cortex and strong adhesion between the vitreous and both the macula and optic disc. To remove the posterior vitreous cortex, high suction was needed.

Conclusion:

Our experience is in line with recent reviews on the good prognostic factors for enzymatic vitreolysis. Based on our surgical experience we hypothesize that our findings are probably compatible with the presence of anomalous posterior vitreous cortex and vitreoschisis. Our findings illustrate the need to better understand vitreoretinal interface in these patients and OCT currently provides the best structural images. Future in vivo studies with High-Resolution OCT (HR-SD-OCT) may be the key to clarify the pathophysiology of the vitreoretinal disorders.


CONTACT DETAILS

 

David Martins
Setubal, Portugal
Email : drdavidmartins@hotmail.com
Cell Phone: +351964029156
Work Phone: +351265549000