Ocriplasmin for Treatment of Vitreomacular Traction: Our Real-world Experience


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 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 reported 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. In this paper we present our experience with ocriplasmin.

Methods:

We selected 16 eyes from 15 patients, with focal vitreomacular tractions or macular hole with a decrease in visual acuity and metam orphopsia. Before the injection, all visual acuities were assessed, visual disturbances were examined and an OCT was performed, in which we measured the diameter and area of adherence (en face mode), as well as the average macular thickness. We administered 125 μm of ocriplasmin in an operating room, via pars plana. Assessments were made at baseline, on the day of injection, and on days 1, 7, 14, 28, 90, and 180 after the injection.

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 demonstrated a VMT release rate of 43.75%. Nowadays, after the review of our cases and other real-life experience reports, we conclude that enzymatic vitreolysis with ocriplasmin is a useful therapeutic option to resolve vitreomacular traction and to close macular holes. The selection of patients is key point to improve the outcomes.


CONTACT DETAILS

 

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