Introduction:

There are many reports supporting that the relationship of the posterior cortical vitreous to the macula plays a role in the development of diabetic macular edema (DME). Until recently, the only treatment option available for vitreomacular adhesion (VMA) was vitrectomy. Given the risks for vitrectomy, the standard of care has generally been to wait until visual symptoms from VMT have deteriorated enough to justify the procedure.

Purpose:

To evaluate the safety and preliminary efficacy of 125µg of a single intravitreal injection of ocriplasmin in patients with diabetic macular edema (DME) and focal or loose broad vitreomacular adhesion/traction (VMA/VMT). METHODS: Interventional, single center observational case series of 15 eyes of 13 patients who received intravitreal ocriplasmin for DME with VMA/VMT. Adjunct treatment, when required, with laser and intravitreal injections of corticosteroids and/or antiangiogenic before or after the injection of ocriplasmin were also performed. The primary endpoint was resolution of vitreomacular adhesion at 1 month post intervention. The secondary endpoints included VMA release or decrease size of VMA over time, total posterior vitreous detachment (PVD), macular edema, best corrected visual acuity (BCVA) changes from baseline and number of anti-vascular endothelial growth factor (VEGF) injections.

Results:

15 eyes of 13 patients were treated with an intravitreal injection of ocriplasmin. The mean follow-up was 169 days (range between 32 and 347). Of the 13 patients, with an average age of 69 years, 54% are male and 60% of the cases are phakic. The mean BCVA pre-injection was 20/50 (ETDRS Scale). Non-proliferative diabetic retinopathy was present in 87% of the eyes. There was history of intravitreal injections (anti-angiogenic and/or steroids) in 80% of cases and 100% laser therapy. The average time of vitreo-macular traction was 9 months. The average measure of traction was 815μm (minimum and maximum values of 128μm and 2765μm, respectively) and an epiretinal membrane was found on OCT in 7% of the cases. Transient reduction in visual acuity, floaters and/or photopsias were the only important side effects verified, described in 40% of patients in the following days after the injection. The release of the TVM occurred in 60% of cases and PVD in 47%. There was an increase of BCVA in 87% of cases (p<0.05). The mean macular thickness decreased from 312.3μm pre-injection to 285.8μm (p=0.014).

Conclusions:

The intravitreal injection of ocriplasmin in DME associated with VMT seems to be a safe and well tolerated procedure and an effective treatment with a significant improvement in visual acuity and macular edema. The anatomical-functional preliminary results suggest that this approach could be a therapeutic alternative in the DME with VMT, being the patient’s selection and the timing of injection crucial for a successful treatment.

Contact Details:

Email: bbtpessoa@gmail.com
Cell Phone: +351938469884

Bernardete Pessoa