Intravitreal Ocriplasmin in DME with Vitreomacular Adhesion in Eyes with Proliferative Diabetic Retinopathy



To evaluate the efficacy of a single intravitreal injection of ocriplasmin (125 µg) in eyes with diabetic macular edema (DME) and focal or loose broad vitreomacular adhesion/traction (VMA) in cases where proliferative diabetic retinopathy (PDR) was present and to compare these results with those obtained in eyes with nonproliferative diabetic retinopathy (NPDR).


Observational single center case series of 5 eyes (5 patients) with PDR who received intravitreal ocriplasmin for DME with VMA. We evaluated VMA release rate, macular edema and best corrected visual acuity (BCVA) in Early Treatment Diabetic Retinopathy Study (ETDRS) letters changes from baseline and the number of intravitreal injections (anti-VEGF) before and after ocriplasmin injection. Anti-VEGF was performed until 3 weeks before ocriplasmin injection, and then in a pro re nata (PRN) regimen. Macular and/or peripheral LASER was performed when required, before and after ocriplasmin injection. We also evaluated the VMA release rate in these patients compared to our patients with NPDR submitted to the same treatment (17 eyes of 14 patients), as well as anatomical and functional outcomes in these two groups.


Of the 5 eyes included in this study, 4 had optic disc neovascularization and 1 had retina elsewhere neovascularization. The mean age was 66 years; 60% were males and 60% were pseudophakic. The mean follow-up was 13.2 months. All eyes received previous treatment with intravitreal injections and LASER therapy. The mean BCVA pre-injection was 70,4 in ETDRS letters. The release of the VMA occurred in 80% of cases and it occurred at day 34 (median; ranging from 4 to 64). In 2 eyes, there was no need of further treatment with intravitreal injections during the considered follow-up. During the follow-up period, the eyes with VMA release had an increase in BCVA of 9 ETDRS letters and a best mean macular thickness decrease of 21.2 µm. When we compared the VMA release rate between the groups with PDR and NPDR, no statistically significant differences were found (p 0.52). Similarly, after ocriplasmin injection there were no statistically significant differences in the number of intra vitreal injections, changes in macular thickness and BCVA between patients with VMA release in the two groups (p >0.05).


In eyes with DME associated with VMA, ocriplasmin injection appears to have promising results. The results of our study suggest that eyes with PDR may benefit from this therapeutic alternative and does not appear to be a poor prognostic factor in response to this treatment. However, studies with larger samples are needed to assess these results.


Ana Carolina Abreu
Porto, Portugal
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