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Quiroz-Reyes MA, Quiroz-Gonzalez EA, Quiroz-Gonzalez MA, Lima-Gomez V. Pneumatic vitreolysis versus vitrectomy for the treatment of vitreomacular traction syndrome and macular holes: complication analysis and systematic review with meta-analysis of functional outcomes. Int J Retina Vitreous 2023; 9:33. [PMID: 37316932 DOI: 10.1186/s40942-023-00472-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/10/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND We conducted a systematic review to compare the effects of pneumatic vitreolysis (PV), enzymatic vitreolysis (EVL) with ocriplasmin, and pars plana vitrectomy (PPV) on vitreomacular traction (VMT) syndrome and macular holes (MHs) to assess their efficacy as treatment options. METHODS Databases, including PubMed, ClinicalTrials.gov ( www. CLINICALTRIALS gov ), the Cochrane Central Register of Controlled Trials (CENTRAL)-including the Cochrane Eyes and Vision Group Trials Register (The Cochrane Library 2013, Issue 2)-, Ovid MEDLINE, and EMBASE (January 2000-October 2022), were searched to identify studies comparing the outcomes of PV versus PPV, PPV versus ocriplasmin and ocriplasmin versus PV. RevMan 5.1 was used for the meta-analysis of the studies. RESULTS Among the 89 studies, 79 were considered eligible for qualitative analysis, and 10 quantitative studies were subjected to meta-analysis. PPV resulted in better postoperative visual acuity improvement than ocriplasmin (standardized mean deviation (SMD) = 0.38, 95% CI 0.03-0.73, p = 0.0003). PV resulted in no significant difference in visual improvement compared with PPV (SMD = - 0.15, 95% CI - 0.47 to 0.16, p = 0.35). PPV was significantly more effective in terms of the VMT release rate (risk ratio = 0.48, 95% CI 0.38-0.62, p = 0.00001) and MH closure rate (risk ratio = 0.49, 95% CI 0.30-0.81, p = 0.006) than ocriplasmin. PV was more effective than ocriplasmin in terms of the VMT release rate (risk ratio = 0.49, 95% CI 0.35-0.70, p = 0.0001). Qualitative analysis showed MH closure rates of 46%, 47.8%, and 95% and VMT releases rates of 46%, 68% and 100% after ocriplasmin, PV, and PPV treatments, respectively. Adverse events and postoperative complications occurring after treatment have also been documented in these studies. CONCLUSION PPV appears to be the most promising option for MH closure and VMT release, with fewer serious complications than EVL or PV. However, given the limited number of studies comparing these treatments, further research is needed to establish the superiority of PPV over the other options.
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Affiliation(s)
- Miguel A Quiroz-Reyes
- Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization), Which is Affiliated with the Postgraduate Studies Division of the National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, Lomas de Chapultepec, 11000, Mexico City, Mexico.
| | - Erick A Quiroz-Gonzalez
- Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization), Which is Affiliated with the Postgraduate Studies Division of the National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, Lomas de Chapultepec, 11000, Mexico City, Mexico
- Institute of Ophthalmology, Fundacion Conde de Valenciana, (Nonprofit Organization), Which is Affiliated with the Postgraduate Studies Division of the National Autonomous University of Mexico, Av. Chimalpopoca 14. Col. Obrera, 06800, Mexico City, Mexico
| | - Miguel A Quiroz-Gonzalez
- Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization), Which is Affiliated with the Postgraduate Studies Division of the National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, Lomas de Chapultepec, 11000, Mexico City, Mexico
| | - Virgilio Lima-Gomez
- Juarez Hospital, Public Assistance Institution (Nonprofit Organization), Av. Politecnico Nacional 5160, Colonia Magdalena de las Salinas, 07760, Mexico City, Mexico
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Pradhan D, Agarwal L, Joshi I, Kushwaha A, Aditya K, Kumari A. Internal limiting membrane peeling in macular hole surgery. Ger Med Sci 2022; 20:Doc07. [PMID: 35813123 PMCID: PMC9204259 DOI: 10.3205/000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/23/2021] [Indexed: 11/18/2022]
Abstract
Since the era when macular hole was considered untreatable, macular hole surgery has come a long way to being one of the most successful surgeries. Internal limiting membrane (ILM) peeling has been an essential step of macular hole surgery since the establishment of the role of ILM in the aetiopathogenesis and progression of macular hole. However, the novel technique was not all virtuous. It had some vices which were not evident immediately. With the advent of spectral domain optical coherence tomography, short- and long-term effects of ILM peeling on macular structures were known; and with microperimetry, its effect on the function of macula could be evaluated. The technique has evolved with time from total peeling to inverted flap to just temporal peeling and temporal flap in an attempt to mitigate its adverse effects and to improve its surgical outcome. ILM abrasion technique and Ocriplasmin may eliminate the need of ILM peeling in selected cases, but they have their own limitations. We here discuss the role of ILM in the pathogenesis of macular hole, the benefits and adverse effects of ILM peeling, and the various modifications of the procedure, to then explore the alternatives.
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Affiliation(s)
- Deepti Pradhan
- Kirtipur Eye Hospital, Department of Vitreoretinal Services, Kirtipur, Nepal,*To whom correspondence should be addressed: Deepti Pradhan, Kirtipur Eye Hospital, Department of Vitreoretinal Services, Tahalcha, Tinkune, 44618 Kirtipur-10, Nepal, Phone: +977 9808119112, E-mail:
| | - Lalit Agarwal
- Biratnagar Eye Hospital, Department of Vitreoretinal Services, Biratnagar, Nepal
| | - Ichhya Joshi
- Biratnagar Eye Hospital, Department of Vitreoretinal Services, Biratnagar, Nepal
| | - Anamika Kushwaha
- Biratnagar Eye Hospital, Department of Vitreoretinal Services, Biratnagar, Nepal
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Baghban R, Farajnia S, Ghasemi Y, Mortazavi M, Samadi N, Zarghami N. Assessment of E. coli Expression System for Overexpression of Active Recombinant Ocriplasmin. Adv Pharm Bull 2021; 11:564-569. [PMID: 34513632 PMCID: PMC8421613 DOI: 10.34172/apb.2021.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/24/2020] [Accepted: 06/21/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose: Ocriplasmin (Jetrea TM) is a FDA approved recombinant enzyme utilized in the treatment of vitreomacular adhesion (VMA). This is a recombinant C-terminal fragment of human plasmin produced using yeast Pichia pastoris. Since ocriplasmin does not contain any Oor N-glycosylation or some other post-translational modifications, bacterial expression systems such as Escherichia coli could be considered as an economical host for recombinant expression. In the present study, we aimed to evaluate the efficiency of E. coli expression system for highlevel expression of recombinant ocriplasmin. Methods: The gene coding for ocriplasmin was cloned and expressed in E. coli BL21. The bacterial cells were cultured on large scale and the expressed recombinant protein was purified using Ni-NTA chromatography. Refolding of denatured ocriplasmin to active enzyme was carried out by the stepwise removal of denaturant. The identity of recombinant ocriplasmin was confirmed using western blotting and ELISA assays. The presence of the active ocriplasmin was monitored by the hydrolytic activity assay against the chromogenic substrate S-2403. Results: The final yield of E. coli BL21-produced ocriplasmin was approximately 1 mg/mL which was greater than that of P. pastoris. Using western blotting and ELISA assay, the identity of recombinant ocriplasmin was confirmed. The hydrolysis of chromogenic substrate S-2403 verified the functional activity of E. coli produced ocriplasmin. Conclusion: The results of this study indicated that E. coli could be used for high level expression of ocriplasmin. Although the recombinant protein was expressed as inclusion body, the stepwise refolding leads to the biologically active proteins.
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Affiliation(s)
- Roghayyeh Baghban
- Medical Biotechnology Department, Faculty of Advanced Medical Science, Tabriz University of Medical Sciences,Tabriz, Iran.,Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.,Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Safar Farajnia
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Younes Ghasemi
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Mojtaba Mortazavi
- Department of Biotechnology, Institute of Science and High Technology and Environmental Science, Graduate University of Advanced Technology, Kerman, Iran
| | - Naser Samadi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nosratollah Zarghami
- Medical Biotechnology Department, Faculty of Advanced Medical Science, Tabriz University of Medical Sciences,Tabriz, Iran
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Khanani AM, Constantine RN, Blot KH, Lescrauwaet B, Szurman P. Effectiveness of ocriplasmin in real-world settings: A systematic literature review, meta-analysis, and comparison with randomized trials. Acta Ophthalmol 2021; 99:e823-e836. [PMID: 33369248 PMCID: PMC8518696 DOI: 10.1111/aos.14686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/06/2020] [Accepted: 10/25/2020] [Indexed: 11/29/2022]
Abstract
Purpose Effectiveness of ocriplasmin for vitreomacular traction (VMT) varies depending on the presence of common ocular conditions and patient selection criteria. We carried out a systematic literature review and meta‐analysis of ocriplasmin studies conducted in real‐world settings (RWS) and compared outcomes with those from randomized controlled trials (RCTs). Methods We included prospective and retrospective studies from RWS documenting effectiveness of ocriplasmin in patients with VMT with or without MH, and RCTs of ocriplasmin versus control. Key end‐points were vitreomacular adhesion resolution (VMAR), nonsurgical MH closure, need for vitrectomy and safety. We conducted meta‐regression on pooled results to evaluate effects of baseline covariates and study design on outcomes. Results Thirty RWS (2402 patients) and 5 RCTs (737 patients) were included epiretinal membrane (ERM) and broad VMA were more prevalent in RCTs. Primary VMAR, vitrectomy and MH closure rates were comparable between RWS and RCTs. Rates of nsVMAR were significantly higher in RWS than RCTs (odds ratio 1.66; 95% confidence interval [CI]: 1.18–2.34). nsVMAR rates were inversely associated with ERM prevalence (odds ratio 0.20; 95% CI: 0.08–0.51). Compared with the recent OASIS trial, RWS reported a higher incidence of new/worsening subretinal fluid cases and less photophobia, photopsia, vitreous floaters, electroretinogram abnormalities and MH progression. Conclusions Ocriplasmin was significantly more effective in achieving nsVMAR in RWS than in RCTs. Lower ERM prevalence in RWS was the single significant explanatory variable for this difference. Conclusions on ocriplasmin safety in RWS are limited due to inconsistent reporting.
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Affiliation(s)
| | | | | | | | - Peter Szurman
- Eye Clinic Sulzbach Knappschaft Hospital Saar Sulzbach Germany
- Klaus Heimann Eye Research Institute (KHERI) Sulzbach Germany
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Joondeph BC, Willems P, Raber T, Duchateau L, Markoff J. Prognostic Factors Associated with Ocriplasmin Efficacy for the Treatment of Symptomatic Vitreomacular Adhesion and Full-thickness Macular Hole: Analysis from Four Studies. J Ophthalmic Vis Res 2021; 16:42-55. [PMID: 33520127 PMCID: PMC7841271 DOI: 10.18502/jovr.v16i1.8250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/23/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the effect of patient baseline characteristics on the efficacy of ocriplasmin treatment for symptomatic vitreomacular adhesion (VMA) with full-thickness macular hole (FTMH) from phase 3/4 studies. Methods Patients with symptomatic VMA and FTMH at baseline and receiving ocriplasmin treatment 125 μg were pooled from the MIVI-TRUST, OASIS, and ORBIT studies. Multivariable logistic regression analysis was used to evaluate whether patient baseline characteristics were predictors of having VMA resolution by Day 28 and FTMH closure by Month 6. Results Two hundred and seventy-four patients receiving ocriplasmin treatment were assessed. Overall, 22.6% (62/274) of the patients experienced both VMA resolution by Day 28 and non-surgical FTMH closure by Month 6. Patients with FTMH ≤250 µm at baseline had a significantly higher success rate compared to those with FTMH >400 µm (29.9% [41/137] vs 2.2% [1/48]; P = 0.009). In patients with VMA resolution by Day 28, both small FTMH size (P = 0.001) and FTMH width at RPE (P = 0.012) were significantly associated with a higher FTMH closure rate. Patients with VMA resolution had higher rates of FTMH closure. Previously identified baseline predictive factors, including age, lens status, or presence of epiretinal membrane (ERM) were not found to be predictive of both VMA release and FTMH closure. Conclusion The analysis revealed that FMTH ≤250 µm was the only factor predictive for achieving both pharmacological VMA resolution by Day 28 and nonsurgical FTMH closure by Month 6; neither lens status or presence of ERM, previously identified baseline characteristics favoring VMA resolution, showed statistically significant predictive power for both outcomes.
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Affiliation(s)
| | | | | | - Luc Duchateau
- Biometrics Research Group, Ghent University, Gent, Belgium
| | - Joseph Markoff
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Thomas Jefferson Medical College, Philadelphia, Pennsylvania, USA
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Baghban R, Farajnia S, Ghasemi Y, Hoseinpoor R, Safary A, Mortazavi M, Zarghami N. Mutational Analysis of Ocriplasmin to Reduce Proteolytic and Autolytic Activity in Pichia pastoris. Biol Proced Online 2020; 22:25. [PMID: 33308171 PMCID: PMC7734836 DOI: 10.1186/s12575-020-00138-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Ocriplasmin (Jetrea) is using for the treatment of symptomatic vitreomacular adhesion. This enzyme undergoes rapid inactivation and limited activity duration as a result of its autolytic nature after injection within the eye. Moreover, the proteolytic activity can cause photoreceptor damage, which may result in visual impairment in more serious cases. RESULTS The present research aimed to reduce the disadvantages of ocriplasmin using site-directed mutagenesis. To reduce the autolytic activity of ocriplasmin in the first variant, lysine 156 changed to glutamic acid and, in the second variant for the proteolytic activity reduction, alanine 59 mutated to threonine. The third variant contained both mutations. Expression of wild type and three mutant variants of ocriplasmin constructs were done in the Pichia pastoris expression system. The mutant variants were analyzed in silico and in vitro and compared to the wild type. The kinetic parameters of ocriplasmin variants showed both variants with K156E substitution were more resistant to autolytic degradation than wild-type. These variants also exhibited reduced Kcat and Vmax values. An increase in their Km values, leading to a decreased catalytic efficiency (the Kcat/Km ratio) of autolytic and mixed variants. Moreover, in the variant with A59T mutation, Kcat and Vmax values have reduced compared to wild type. The mix variants showed the most increase in Km value (almost 2-fold) as well as reduced enzymatic affinity to the substrate. Thus, the results indicated that combined mutations at the ocriplasmin sequence were more effective compared with single mutations. CONCLUSIONS The results indicated such variants represent valuable tools for the investigation of therapeutic strategies aiming at the non-surgical resolution of vitreomacular adhesion.
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Affiliation(s)
- Roghayyeh Baghban
- Medical Biotechnology Department, Faculty of Advanced Medical Science, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Biotechnology Research Center, Tabriz University of Medical Sciences, Daneshgah Ave, Tabriz, Iran
| | - Safar Farajnia
- Biotechnology Research Center, Tabriz University of Medical Sciences, Daneshgah Ave, Tabriz, Iran.
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Younes Ghasemi
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Reyhaneh Hoseinpoor
- Department of Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azam Safary
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojtaba Mortazavi
- Department of Biotechnology, Institute of Science and High Technology and Environmental Science, Graduate University of Advanced Technology, Kerman, Iran
| | - Nosratollah Zarghami
- Medical Biotechnology Department, Faculty of Advanced Medical Science, Tabriz University of Medical Sciences, Tabriz, Iran
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Katsanos A, Gorgoli K, Asproudis I, Stefaniotou M. Recurrent Vitreomacular Traction in a Patient Treated with Ocriplasmin: A Case Report. Ophthalmol Ther 2021; 10:187-92. [PMID: 33108639 DOI: 10.1007/s40123-020-00316-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/15/2020] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION To describe a case of recurrent vitreomacular traction and macular edema that appeared both before and after the intravitreal injection of ocriplasmin. CASE REPORT An 82-year-old monocular man presented with metamorphopsia and reduced vision of 1-week duration. The patient's general medical history was unremarkable. His ophthalmic history was significant for severe ocular trauma in the right eye in childhood that caused phthisis. The left eye had undergone uncomplicated phacoemulsification 3 months earlier and the 1-month postoperative best corrected visual acuity (BCVA) was logarithmic mean angle of resolution (logMAR) 0.0. There was no history of other ocular conditions. At presentation, BCVA was logMAR 0.2 and optical coherence tomography (OCT) revealed the presence of cystoid macular edema caused by vitreomacular traction (VMT). The patient was scheduled for intravitreal ocriplasmin injection. Prior to treatment, the vision improved spontaneously to logMAR 0.1, and no VMT could be detected with spectral domain (SD)-OCT. The ocriplasmin injection was deferred but 3 weeks later the patient presented again with metamorphopsia, while VMT was again evident on SD-OCT. Ocriplasmin was injected and 1 month later the BCVA reached logMAR 0.1 without VMT. However, at 2 months post injection the VMT reappeared and a conservative approach with observation and topical nepafenac administration was decided. At the 3-month post-injection visit there was no VMT. More than 3 years after the ocriplasmin injection there is still no evidence of VMT, the patient is free of metamorphopsia, and his BCVA is logMAR 0.0. CONCLUSION Separation of consecutive layers of the vitreous cortex (vitreoschisis) may account for recurrent VMT.
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Goh LY, Motta L, Jackson TL. Myopic macular hole detachment associated with intravitreal ocriplasmin. Am J Ophthalmol Case Rep 2020; 19:100697. [PMID: 32637726 PMCID: PMC7327198 DOI: 10.1016/j.ajoc.2020.100697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/26/2020] [Accepted: 04/02/2020] [Indexed: 12/04/2022] Open
Abstract
Purpose To describe a case of macular hole retinal detachment in a high myope following intravitreal ocriplasmin injection. Observations A 71-year-old highly myopic (−18.63 Dioptres) female received 125 μg of intravitreal ocriplasmin (Jetrea, Oxurion, Leuven, Belgium) to treat a right, full-thickness macular hole (FTMH) with vitreomacular adhesion. Presenting best-corrected visual acuity (BCVA) letter score was 45, using the Early Treatment Diabetic Retinopathy Study chart. Past ocular history in the affected, pseudophakic eye included anisometropic amblyopia, but with a documented pre-morbid BCVA of 75 letters. One week post-injection the vitreomacular adhesion persisted. One month post-injection, a large posterior macular hole retinal detachment developed with BCVA of 45 letters. Over the course of one year she underwent three pars plana vitrectomies aiming to treat the retinal detachment and close the FTMH. The detachment was treated successfully but the FTMH persisted, albeit with a reduced diameter. Final BCVA was 55 letters. Conclusions The pathogenesis of this macular hole detachment may be related to the combination of a FTMH and high myopia. Ocriplasmin functions in a twofold manner; inducing a posterior vitreous detachment and as a proteolytic enzyme digesting the fibronectin and laminin at the pathological vitreoretinal interface. With access through a FTMH, ocriplasmin may exert an enzymatic effect on the interphotoreceptor matrix and the photoreceptor-retinal pigment epithelium interface that normally helps maintain neuroretinal adhesion to the retinal pigment epithelium. The reported increase in basal diameter of FTMHs following ocriplasmin supports this hypothesis. High myopia was another likely contributing factor. Highly myopic patients were excluded from the initial ocriplasmin registration studies, mainly due to the risk of retinal detachment, but were eligible for subsequent large trials. Importance Clinicians should be aware of a potential association between ocriplasmin and macular hole detachments in eyes with high myopia.
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Affiliation(s)
- Li Yen Goh
- Department of Ophthalmology, King's College Hospital, London, United Kingdom
| | - Lorenzo Motta
- Department of Ophthalmology, King's College Hospital, London, United Kingdom
| | - Timothy L. Jackson
- Department of Ophthalmology, King's College Hospital, London, United Kingdom
- Faculty of Life Science and Medicine, King's College London, London, United Kingdom
- Corresponding author. FRCOphth King's College London Department of Ophthalmology King's College Hospital, London, SE5 9RS, United Kingdom.
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Cacciamani A, Gattegna R, Pileri M, Di Nicola M, Bardanzellu S, Facciolo G, Cosimi P, Govetto A, Scarinci F. Short-term changes in posterior vitreous cortex following intravitreal ocriplasmin for symptomatic vitreomacular traction syndrome: a prospective study. Int Ophthalmol 2020; 40:185-93. [PMID: 31565760 DOI: 10.1007/s10792-019-01177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To describe and analyze short-term posterior vitreous abnormalities following intravitreal ocriplasmin in eyes with symptomatic vitreomacular traction syndrome (VMT). METHODS In this institutional, prospective and interventional study enrolled patients with symptomatic focal VMT syndrome treated with intravitreal ocriplasmin. In all cases, spectral-domain optical coherence tomography scans were quantitatively and qualitatively analyzed preoperatively and at 1 and 4 weeks postoperatively. RESULTS Twenty-three patients, of which 5 were males and 18 females, with a mean age of 69.5 ± 8.2 years were included in this study. Postoperatively, VMT resolved in 11 of 23 eyes (47.8%). In 9 out of 11 cases (81.8%), VMT resolved by postoperative week 1, whether in the remaining 2 (18.2%) anatomical restoration, was diagnosed at postoperative week 4. At postoperative week 1, a foveolar detachment was detected in 9 out of 23 eyes (39.1%). The foveolar detachment resolved all but one eye by the end of postoperative week 4. At the end of the follow-up period, the presence of subretinal fluid was detected in 7 out of 9 eyes (77.8%), and it was significantly associated with a shrinkage of the posterior vitreous cortex (p < 0.006). At the end of the follow-up period, visual acuity was significantly higher in those eyes with VMT resolution (p < 0.001). CONCLUSION Intravitreal ocriplasmin is effective for the treatment of patients with VMT. The postoperative presence of posterior hyaloid shrinkage may be associated with higher traction over the foveal area and the appearance of foveolar detachment.
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Groselli S, Wehrmann K, Rüther K, Feucht N, Lohmann CP, Maier M. [Microstructural retinal changes after pharmacological vitreolysis with ocriplasmin-an SD-OCT supported analysis]. Ophthalmologe 2020; 117:260-6. [PMID: 31346704 DOI: 10.1007/s00347-019-0944-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Ocriplasmin (Jetrea®) is a therapeutic option for patients with focal vitreomacular traction (VMT) with or without small full thickness macular holes (FTMH) < 400 µm. Retinal alterations after injection with ocriplasmin have been described. The purpose of this essay was to determine Ocriplasmin-associated side-effects and changes in the retinal microstructure. METHODS We included 70 patients with ocriplasmin treatment in our study. On all patients SD-OCT (spectral-domain optical coherence tomography) scans were performed prior to injection with Ocriplasmin. If present, adverse events were registered. The OCT scans were then evaluated taking the following into account: macular hole (MH) size, macular edema, subretinal fluid (SRF), changes in the ellipsoid zone (EZ) and the external limiting membrane (ELM). RESULTS Twenty of the 70 examined patients showed a preoperative FTMH. One week after ocriplasmin IVI (intravitreal injection) 8 of the 20 FTMHs were already closed. Overall 12 patients showed a FTMH closure and 4 patients developed a FTMH after ocriplasmin IVI. Twelve of the 24 MH (macular hole) patients still required an operative closure of the FTMH. We noticed a resolution of the VMT on 51 patients. Three patients developed a retinal detachment. Furthermore, after ocriplasmin IVI we detected changes in the EZ and ELM on 8 patients. CONCLUSIONS Ocriplasmin is a substantial minimal invasive option in the therapy of VMT with or without small FTMH. Nevertheless, there seem to be some specific ocriplasmin-associated risks, although usually transient. Severe complications like retinal detachment are rare but exist. Therefore, every indication of ocriplasmin should be considered carefully.
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Iuliano L, Fogliato G, Colombo R, Sacconi R, Querques G, Bandello F, Codenotti M. Reduced perfusion density of superficial retinal capillary plexus after intravitreal ocriplasmin injection for idiopathic vitreomacular traction. BMC Ophthalmol 2019; 19:108. [PMID: 31077176 PMCID: PMC6511184 DOI: 10.1186/s12886-019-1119-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 05/02/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND To investigate, using optical coherence tomography angiography (OCT-A), changes in perfusion density and in the foveal avascular zone (FAZ) in eyes with idiopathic vitreomacular traction (VMT) after ocriplasmin injection. METHODS In this pilot study, we enrolled sixteen VMT eyes treated with intravitreal ocriplasmin injection. Sixteen healthy eyes were considered as controls. Macular perfusion density in 3 plexuses [superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC)] was calculated at baseline and at 1 month after injection. RESULTS After injection, VMT anatomically resolved in 9 eyes (56.2%), whereas 7 eyes (43.8%) achieved an incomplete VMT separation. Superficial capillary plexus perfusion density was reduced significantly after injection (from 0.427 ± 0.027 to 0.413 ± 0.028; p = 0.0146), while no differences were noted in the DCP (p = 0.2717) nor in the CC (p = 0.6848). Study-eye perfusion density was statistically similar to control eyes in all three plexuses, both at baseline and at follow-up. The FAZ in the SCP area remained unchanged after injection (p = 0.168) but was significantly inferior to controls both at baseline and at 1 month (0.198 ± 0.074 vs. 0.196 ± 0.070; p = 0.007). CONCLUSIONS Eyes with VMT have a perfusion density comparable to healthy controls, but a smaller FAZ. After ocriplasmin injection the perfusion density in the SCP is reduced, regardless the anatomical success. Limited by the small sample size and the pilot nature of the study, we found microvascular changes after ocriplasmin injection, which may be due to retinal traction release.
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Affiliation(s)
- Lorenzo Iuliano
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Giovanni Fogliato
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Roberta Colombo
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
| | - Francesco Bandello
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Marco Codenotti
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
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12
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Pirani V, Pelliccioni P, Cesari C, Carrozzi G, Cavallero E, Mariotti C. Flare changes after intravitreal injection of ocriplasmin in symptomatic vitreomacular traction syndrome. Jpn J Ophthalmol 2019; 63:255-61. [PMID: 30805734 DOI: 10.1007/s10384-019-00660-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/27/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate the changes in anterior chamber flare after a single intravitreal injection of ocriplasmin (125 μg), in patients with symptomatic vitreomacular traction syndrome (VMT). STUDY DESIGN An institutional review board-approved single-center not randomized prospective study. METHODS Fifteen eyes of fifteen patients (9 women, 6 men) underwent intravitreal injection with ocriplasmin for symptomatic VMT (width of attachment ≤ 1500 μm). Anterior segment flare was measured with a laser flare meter (Kowa) before intravitreal injection and 1 day, 1 week, 1 month after injection. The changes in flare were analyzed; the resolution of VMT was evaluated with spectral-domain OCT. RESULTS The mean anterior chamber flare was 10.5 ± 1.9 photons per millisecond (photons/ms) before the injection. After 1 day it increased to 13.6 ± 2.7 photons/ms (p = 0.027) and after 1 week to 14.4 ± 2.5 photons/ms (p = 0.005); after 1 month it decreased to 12.3 ± 2.3 photons/ms (p = 0.123). At 1 day and 1 week after injection, mean anterior chamber flare of fellow eyes was significantly lower than study eyes, while at 1 month this difference was not significant (12.3 ± 2.3 vs. 10.5 ± 1.8 photons/ms, p = 0.124, for study and fellow eyes). There was no statistically significant difference in the changes in flare between women and men or between phakic (N = 10) and pseudophakic (N = 5) eyes. No eye demonstrated intraretinal damage at any time-point. Also, 9 eyes showed resolution of VMT while 6 eyes demonstrated persistence of VMT. CONCLUSION Our study shows that intravitreal injection of ocriplasmin can be a safe and effective approach to treat symptomatic VMT syndrome in selected patients.
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13
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Chow N, Hong T, Chang A. Multimodal imaging of macular subretinal deposits following intravitreal ocriplasmin injection. Am J Ophthalmol Case Rep 2018; 9:80-84. [PMID: 29468225 PMCID: PMC5786887 DOI: 10.1016/j.ajoc.2018.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 11/03/2022] Open
Abstract
Purpose Ocriplasmin is effective in closing macular holes due to vitreomacular traction. We present a case of macular subretinal material deposition observed with spectral-domain optical coherence tomography (SD-OCT) and multimodal imaging, following successful closure of a macular hole following intravitreal ocriplasmin injection. Observations An 81-year-old male presented with decreased vision in the left eye due to a full-thickness macular hole secondary to vitreomacular traction. Ocriplasmin (Jetrea) was injected into the vitreous and hole closure was observed after one week. Macular subretinal material deposition developed along the outer surface of the resultant serous detachment on OCT one week post-injection. Fluorescein angiography demonstrated no expanding hyperfluorescence due to retinal or choroidal leak, or staining of the lesion. The material was mildly autofluorescent. The macular subretinal material complex spontaneously decreased with no significant effect on vision over 60 weeks. Conclusions and importance Macular subretinal material deposition has not previously been reported following intravitreal ocriplasmin injection. This material is likely composed of photoreceptor outer segments. It is important to recognize that macular subretinal deposits can occur following intravitreal ocriplasmin injection as it may cause diagnostic confusion and potentially influence the visual and anatomical outcomes following successful hole closure.
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Affiliation(s)
- Nicholas Chow
- Sydney Retina Clinic & Day Surgery, (Lvl 13) 187 Macquarie St, Sydney, NSW, Australia.,Sydney Institute of Vision Science, (Lvl 7) 187 Macquarie St, Sydney, NSW, Australia
| | - Thomas Hong
- Sydney Retina Clinic & Day Surgery, (Lvl 13) 187 Macquarie St, Sydney, NSW, Australia.,Sydney Institute of Vision Science, (Lvl 7) 187 Macquarie St, Sydney, NSW, Australia
| | - Andrew Chang
- Sydney Retina Clinic & Day Surgery, (Lvl 13) 187 Macquarie St, Sydney, NSW, Australia.,Sydney Institute of Vision Science, (Lvl 7) 187 Macquarie St, Sydney, NSW, Australia.,Save Sight Institute, 8 Macquarie St, Sydney, NSW, Australia
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14
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Udaondo P, Barreiro-González A, García-Delpech S, Martínez-Costa R, Cisneros-Lanuza Á. Ocriplasmin retinopathy: Possible cause of macular hole closure failure. ACTA ACUST UNITED AC 2018; 93:239-241. [PMID: 29402498 DOI: 10.1016/j.oftal.2017.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 11/16/2022]
Abstract
CASE REPORT A 53 year-old woman with a stage 2 macular hole received ocriplasmin injection as a first approach. She subsequently underwent pars plana vitrectomy due to enlargement of the hole post-injection. The visual gain following the surgery was minimal despite closure of the hole. This could be explained by outer retina atrophy as a consequence of potential toxic mechanisms related to ocriplasmin. DISCUSSION Further studies may be warranted to fully understand the impact of ocriplasmin on long-term visual function.
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Affiliation(s)
- P Udaondo
- Servicio de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - A Barreiro-González
- Servicio de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - S García-Delpech
- Servicio de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - R Martínez-Costa
- Servicio de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Á Cisneros-Lanuza
- Servicio de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España
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15
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Maier M, Abraham S, Frank C, Lohmann CP, Feucht N. [Pharmaological vitreolysis with ocriplasmin as a treatment option for symptomatic focal vitreomacular traction with or without macular holes (≤400 μm) compared to tranconjunctival vitrectomy]. Ophthalmologe 2017; 114:148-54. [PMID: 27444007 DOI: 10.1007/s00347-016-0322-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND To evaluate the resolution rate in patients with symptomatic vitreomacular traction (VMT) ≤ 1500 μm with or without macular holes ≤ 400 μm after therapy with intravitreal ocriplasmin (Jetrea®) injections in a clinical setting in comparison to transconjunctival vitrectomy. MATERIALS AND METHODS We examined 21 eyes of 21 consecutive patients with vitreomacular traction with or without macular holes who underwent intravitreal injection of 0.1 ml ocriplasmin and we retrospectively reviewed 18 eyes of 18 patients with VMT with or without FTMH who underwent 23-gauge vitrectomy. RESULTS Vitreomacular traction resolved in 15 of 21 eyes treated with ocriplasmin after 6 month (71 %) compared to 100 % of eyes treated by vitrectomy. Of the 5 eyes that initially presented FTMH with VMT in the ocriplasmin group, 2 were closed 1 month after ocriplasmin treatment. The remaining 3 had vitrectomy and closed thereafter. Best corrected visual acuity was 0.38 ± 0.23 LogMAR at baseline, improving to 0.34 ± 0.24 LogMAR at 6 months after ocriplasmin treatment. Best corrected visual acuity in the vitrectomy group improved from 0.55 ± 0.29 LogMAR before operation to 0.53 ± 0.51 LogMAR 6 months postoperatively. Foveal thickness was 355.95 ± 114.53 μm at baseline, reducing to 277.77 ± 40.26 μm at 6 months after ocriplasmin treatment. Foveal thickness of eyes that underwent vitrectomy was 494.61 ± 126.02 μm at baseline, decreasing to 330.2 ± 88.85 μm 6 months postoperatively. CONCLUSION When traction is ≤ 1500 μm, enzymatic vitreolysis with ocriplasmin is a therapeutic option. In the presence of VMT >1500 μm or ERM, surgical treatment with vitrectomy is associated with better outcomes. In small macular holes with VMT and in the absence of ERM, enzymatic vitreolysis with ocriplasmin is an option. In cases of holes >400 μm, or in the absence of evident VMT, or in the presence of ERM, vitrectomy is the first choice.
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16
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Chan CK, Mein CE, Crosson JN. Pneumatic Vitreolysis for Management of Symptomatic Focal Vitreomacular Traction. J Ophthalmic Vis Res 2017; 12:419-423. [PMID: 29090053 PMCID: PMC5644410 DOI: 10.4103/jovr.jovr_146_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 08/03/2017] [Indexed: 11/06/2022] Open
Abstract
Pneumatic vitreolysis (PVL) is the intravitreal injection of a small quantity of expansile gas for the purpose of achieving focal vitreomacular traction (VMT) release for eyes with symptomatic VMT, or inducing VMT release and closure of the macular defect for eyes with a small stage-2 macular hole (MH). Initially, there was limited interest in this technique upon its introduction for clinical treatment in human eyes in 1993. With the advent of optical coherence tomography allowing detailed observation of vitreomacular interface changes and rising importance of medical economics in recent years, there has been increasing interest in PVL, a low-cost procedure for managing symptomatic VMT. The success rates of VMT release in the literature have ranged from 60% to 100% and the rates of closure of small macular holes have ranged from 50% to 80% following PVL. In a recent retrospective consecutive series of 56 eyes in two centers undergoing C3F8 gas injection, Chan and Mein reported an overall success of 86% in VMT release and 60% closure of small macular holes with few adverse events (7% with retinal breaks, retinal detachment, or progression of VMT). Multiple recent studies have shown superior outcome utilizing C3F8 gas compared with SF6 gas for PVL. In conclusion, PVL is a promising, low-cost therapeutic option, with the potential for managing symptomatic focal VMT on a global scale.
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Affiliation(s)
- Clement K. Chan
- Southern California Desert Retina Consultants, Palm Desert, CA, USA
- Department of Ophthalmology, Loma Linda University, Loma Linda, CA, USA
| | - Calvin E. Mein
- Retinal Consultants of San Antonio, San Antonio, TX, USA
- Department of ophthalmology, University of Texas Health, San Antonio, TX, USA
| | - Jason N. Crosson
- Retina Consultants of Alabama, Department of Ophthalmology, the University of Alabama at Birmingham, Birmingham, AL, USA
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17
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Schumann RG, Langer J, Compera D, Luedtke K, Schaumberger MM, Kreutzer T, Mayer WJ, Wolf A, Priglinger SG. Assessment of intravitreal ocriplasmin treatment for vitreomacular traction in clinical practice. Graefes Arch Clin Exp Ophthalmol 2017; 255:2081-2089. [PMID: 28755165 DOI: 10.1007/s00417-017-3747-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/29/2017] [Accepted: 07/05/2017] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess treatment effects following intravitreal injection of ocriplasmin for vitreomacular traction (VMT), with or without full-thickness macular hole (FTMH), in real-life setting. METHODS This is a monocentric, retrospective, consecutive series of 82 eyes from 82 patients who underwent ocriplasmin treatment between July 2013 and December 2016. We included 57 eyes with pure VMT, 17 eyes with small FTMHs, and eight eyes with medium FTMHs. Primary outcome measures were VMT release and MH closure rates. Secondary outcomes were visual acuity (VA), morphological changes, and subjective visual impairment after 1, 3, and 6 months and at last follow-up. RESULTS After a median follow-up of 10 months, VMT release was achieved by pharmacologic vitreolysis in 57% of all eyes, whereas the macular hole closure rate was 32%. In those presenting with five or more positive prognostic factors (PPF), eyes with pure VMT showed nonsurgical traction release in 88%, and FTMHs were released in 93%, with a closure rate of 20%. Small FTMHs closed in 41% and medium FTMHs in 13%. The mean change in VA (LogMAR) was -0.07 ± 0.24 (median - 0.10) in all eyes. Subretinal fluid accumulation and ellipsoid zone changes were seen in 31% and 37% of all eyes, respectively. They were more frequent in eyes with traction release, but were self-limited. CONCLUSIONS In a real-life setting, release of VMT by ocriplasmin injection can be achieved in the majority of eyes, relying on a strict patient selection. Closure of FTMHs rather correlates with hole diameter than with presence of PPF, and remains a rare finding in medium FTMHs.
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Affiliation(s)
- Ricarda G Schumann
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany.
| | - Julian Langer
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Denise Compera
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Katharina Luedtke
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Markus M Schaumberger
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Thomas Kreutzer
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Wolfgang J Mayer
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Armin Wolf
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Siegfried G Priglinger
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
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18
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Manousaridis K, Peter-Reichart S, Mennel S. Ocriplasmin treatment for vitreomacular traction in real life: can the indication spectrum be expanded? Graefes Arch Clin Exp Ophthalmol 2017; 255:1907-1916. [PMID: 28681138 DOI: 10.1007/s00417-017-3731-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/13/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate the efficacy of intravitreal ocriplasmin for the resolution of vitreomacular traction (VMT) with or without a full thickness macular hole (FTMH) in the clinical setting and to assess whether the indication spectrum of this treatment modality can be expanded beyond that of the MIVI-TRUST trials. METHODS The records of patients with VMT with or without FTMH, who were treated with intravitreal ocriplasmin were reviewed. Patients were divided in two groups. In the first group, VMT with or without FTMH was present without any other macular pathology. In the second group, VMT with or without FTMH occurred alongside of other macular disease including age-related macular degeneration, diabetic maculopathy and post-operative pseudophakic cystoid macular edema. RESULTS Release of the VMT was achieved in 12/20 patients (12/20 eyes) of the first group. 16 eyes in this group met 3 or more criteria known to be associated with favorable prognosis after intravitreal ocriplasmin treatment. No cases of release of the VMT were observed in the second group, which included 15 patients (15 eyes). Significant improvement of visual acuity and reduction of the central macular thickness was observed only in the subgroup of eyes which responded to treatment. CONCLUSIONS Concomitant macular pathology was a significant factor for treatment failure and we suggest that ocriplasmin should be regarded with caution in these cases. Careful patient selection for treatment with ocriplasmin using specific criteria in the clinical setting can provide superior results to those reported in the MIVI-TRUST trials.
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Affiliation(s)
- Kleanthis Manousaridis
- Ophthalmology Department, State Hospital Feldkirch, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria.
| | - Silvia Peter-Reichart
- Ophthalmology Department, State Hospital Feldkirch, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria
| | - Stefan Mennel
- Ophthalmology Department, State Hospital Feldkirch, Academic Teaching Hospital, Carinagasse 47, 6800, Feldkirch, Austria
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19
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Bertelmann T, Wachtlin J, Mennel S, Koss MJ, Maier MM, Schumann RG, Kazerounian S, Daniel H, Schmitz-Valckenberg S; EXPORT study group. The predictability of ocriplasmin treatment effects: is there consensus among retinal experts? Results from the EXPORT study. Graefes Arch Clin Exp Ophthalmol 2017; 255:1359-67. [PMID: 28389700 DOI: 10.1007/s00417-017-3657-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 03/13/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate the agreement and predictability of ocriplasmin treatment effects among retinal experts (raters) by assessment of retinal imaging data of eyes treated for vitreomacular traction in nine different centers in Germany and Austria. METHODS Retrospective cohort study. Combined confocal near-infrared scanning laser ophthalmoscopy and spectral-domain optical coherence tomography images (Spectralis® device, Heidelberg Engineering GmbH, Germany) from 136 eyes of 135 subjects were reviewed by 14 raters using an internet-based grading database and a standardized questionnaire. In addition to the images taken within 2 days prior to treatment, age, gender, and lens status were disclosed to the raters. Treatment success was defined as a complete cleavage of the posterior vitreous cortex at day 28±5. Main outcome was the agreement and predictability among raters for assessment of treatment success. RESULTS Raters generally accepted starting ocriplasmin treatment (chance for treatment success ≥ 1%) in 22.4 to 69.1% (median 53.2%) of eyes (moderate intra- and interrater agreements with kappa-values of 0.6 and 0.48). The likelihood for a high potential treatment success (equal or higher than 25%) was judged by the raters in 43.4% to 86.0% (median 62.6%) of eyes (moderate intra- and fair interrater agreements with kappa-values of 0.56 and 0.22). Allocating eyes for high potential treatment success overall increased the odds by 3.07, with odds ratios of single raters up to 4.06 to 6.16. CONCLUSIONS These results underscore the importance of training health care providers in the evaluation of retinal imaging data and also to define characteristic morphological features better in the presence of vitreoretinal interface diseases. The better results of single raters in the predictability of treatment success by the allocation of eyes in the high-potential group indicates the high relevance of the meticulous analysis of retinal images.
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Abstract
Pharmacologic vitreolysis with ocriplasmin, a 27 kilodalton serine protease, is an effective nonsurgical treatment option for vitreomacular traction (VMT). Data from phase III clinical studies, including the Microplasmin for Intravitreal Injection-Traction Release without Surgical Treatment (MIVI-TRUST) and Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion Including Macular Hole (OASIS) studies, have demonstrated the treatment efficacy of ocriplasmin for VMT and full-thickness macular hole (FTMH). Subgroup analysis of these clinical trials as well as post-marketing clinical series have aided in patient selection by identifying features associated with successful pharmacologic release of VMT with ocriplasmin, including adhesion diameter ≤1500 μm, absence of epiretinal membrane, phakic status, and age younger than 65. As a first-in-class therapeutic, ocriplasmin and its side effects have been carefully monitored by the vitreoretinal community. The following categories of related or possibly related adverse events have been identified: acute reduction in visual acuity, ERG changes, dyschromatopsia, retinal tear or detachment, lens subluxation or phacodonesis, abnormal pupillary reflex, retinal vascular changes, and OCT ellipsoid zone alterations. Adverse events have almost all been transient with restoration of visual acuity; however, in select patients, alterations may persist.
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Affiliation(s)
- Mohammed Ali Khan
- Retina Division, Department of Ophthalmology, Doheny Eye Center UCLA, Pasadena, CA, USA.,Retina Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Julia A Haller
- Retina Service, Wills Eye Hospital, Philadelphia, PA, USA.
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21
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Rossi S, Testa F, Melillo P, Orrico A, Della Corte M, Simonelli F. Functional improvement assessed by multifocal electroretinogram after Ocriplasmin treatment for vitreomacular traction. BMC Ophthalmol 2016; 16:110. [PMID: 27430356 PMCID: PMC4949888 DOI: 10.1186/s12886-016-0284-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 06/22/2016] [Indexed: 11/26/2022] Open
Abstract
Background To evaluate the functional recovery of patients with symptomatic vitreomacular traction (VMT) after Ocriplasmin treatment. Methods Prospective, single centre, consecutive case series. Patients were treated with a single intravitreal injection of Ocriplasmin (Jetrea, Thrombogenics Inc, USA, Alcon/Novartis EU). The following outcome measures are considered: resolution of VMT, evaluated through the use of optical coherence tomography (SD-OCT), functional recovery evidenced by multifocal-electroretinogram (mfERG) and microperimetry (MP1) after treatment with Ocriplasmin. Results Four eyes of four patients were treated with Ocriplasmin injection. We observed a VMT non-surgical resolution in all patients. The longitudinal statistical analysis showed a significant improvement of best corrected visual acuity (BCVA) in the treated eye of about 0.97 letters/week (p = 0.033). No significant difference was observed in mean sensitivity (p > 0.05) assessed by MP1 in both eyes, while improvement in fixation stability was assessed in treated eyes (β = 0.39; p = 0.029). In the four treated eyes mfERG revealed an increased foveal peak response over the follow-up. The longitudinal analysis of mfERG data shows a significant increase of N1 and P1 amplitude in the first rings and a significant decrease of N1 and P1 implicit time in most rings. Conclusions We report on four cases with resolution of VMT after Ocriplasmin treatment. Our preliminary results demonstrate that Ocriplasmin is safe and effective in the treatment of VMT, because it not only leads to a morphological recovery but mostly to a restoration of macular functionality, evaluated through the use of different objective tests, such as MP1 and mfERG over a six-month follow-up. Electronic supplementary material The online version of this article (doi:10.1186/s12886-016-0284-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Settimio Rossi
- Eye clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, Second University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Francesco Testa
- Eye clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, Second University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Paolo Melillo
- Eye clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, Second University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Ada Orrico
- Eye clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, Second University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Michele Della Corte
- Eye clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, Second University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Francesca Simonelli
- Eye clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, Second University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
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Madi HA, Haynes RJ, Depla D, de la Cour MD, Lesnik-Oberstein S, Muqit MMK, Patton N, Price N, Steel DHW. Rhegmatogenous retinal detachment following intravitreal ocriplasmin. Graefes Arch Clin Exp Ophthalmol 2016; 254:2333-2338. [PMID: 27278373 PMCID: PMC5116307 DOI: 10.1007/s00417-016-3398-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/03/2016] [Accepted: 05/24/2016] [Indexed: 11/12/2022] Open
Abstract
Purpose To describe the characteristics and outcomes of patients presenting with rhegmatogenous retinal detachment (RRD) after ocriplasmin (OCP) injection. Methods Retrospective, multi-centre, observational case series with case note review. Results Eight patients with symptomatic vitreomacular traction (six with concomitant macular hole) were diagnosed with RRD after a median of 16 days (range 3–131 days) post-OCP injection. Presentation was within 3 weeks of the OCP injection in six of the cases. Five patients presented with symptoms post-OCP, and three were diagnosed asymptomatically on planned visits. Seven cases were phakic, one had high myopia (>8 dioptres), and two cases had lattice degeneration. Following RRD surgery, hole closure was achieved in 5/6 MH cases. The final median BCVA at 7 months was 20/80 (range 20/40–20/1200) similar to the baseline BCVA 20/80, with four patients gaining ≥1 line of vision compared to baseline but three losing ≥3 lines. Conclusions RRD is a non-negligible risk associated with intravitreal OCP, and it should be used with caution in eyes with high myopia and peripheral retinal pathology predisposing to RRD. Detailed peripheral retinal examination is recommended pre- and postoperatively at all visits. Patients should be advised to seek attention if symptoms recur after initial presentation.
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Affiliation(s)
- Haifa A Madi
- Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, SR2 9HP, UK
| | | | - Diana Depla
- Ophthalmology Department, Cumberland Infirmary, Carlisle, UK
| | - Morten D de la Cour
- Eye Department, Rigshospitalet, Glostrup, Ndr. Ringvej 57, 2600, Glostrup, Denmark
| | - Sarit Lesnik-Oberstein
- Department of Ophthalmology, Academic Medical Centre, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands
| | - Mahi M K Muqit
- Vitreoretinal Service, Moorfields Eye Hospital, City Road, London, UK
| | - Niall Patton
- Manchester Royal Eye Hospital, Oxford Road, Manchester, UK
| | - Nick Price
- Royal Wolverhampton NHS Trust, Wolverhampton & Midland Counties Eye Infirmary, Wolverhampton, UK
| | - David H W Steel
- Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, SR2 9HP, UK. .,Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK.
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García-Pérez L, Abreu-González R, Pérez-Ramos J, García-Pérez S, Serrano-Aguilar P. Review of economic studies and budget impact analysis of ocriplasmin as a treatment of vitreomacular traction. Arch Soc Esp Oftalmol 2016; 91:257-264. [PMID: 26920947 DOI: 10.1016/j.oftal.2016.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To review the evidence on the cost-effectiveness of ocriplasmin as a treatment for vitreomacular traction (VMT), and to estimate the impact on the Spanish National Health System (NHS). MATERIAL AND METHODS 1) Systematic review. The following databases were searched in January 2015: MEDLINE, PREMEDLINE, EMBASE, CRD, the Cochrane Library, and key websites. Selection criteria were: full economic evaluations that compared ocriplasmin with usual care ('watch and wait' and/or vitrectomy) in patients with VMT. The outcomes to extract were costs of the alternatives and the incremental cost-effectiveness ratio. Studies of budget impact analysis were also included. The methodological quality was assessed, and a narrative synthesis of the included studies was carried out. 2) Estimation of budget impact. The impact on the budget as a result of the introduction of ocriplasmin in the NHS was estimated, including data from different sources. RESULTS Six studies were identified, none of them performed in Spain. The two best studies concluded that ocriplasmin is cost-effective in their respective countries (Canada and United Kingdom), but only in patients with certain conditions (without epiretinal membrane, for example). The results of the budget impact analysis are different between countries. The analysis for Spain showed that the introduction of ocriplasmin would mean a saving over 1 million Euros for the NHS in 5 years. CONCLUSIONS The cost-effectiveness of ocriplasmin has not been demonstrated in Spain. However, good studies performed in other countries found that ocriplasmin is cost-effective in selected patients. Given the current prices in Spain, ocriplasmin could involve a saving for the Spanish NHS.
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Affiliation(s)
- L García-Pérez
- Servicio de Evaluación, Servicio Canario de la Salud (SESCS), Tenerife, España; Fundación Canaria de Investigación Sanitaria (FUNCANIS), Tenerife, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, España.
| | - R Abreu-González
- Servicio de Oftalmología, Hospital Universitario Nuestra Señora de La Candelaria, Tenerife, España
| | - J Pérez-Ramos
- Servicio de Evaluación, Servicio Canario de la Salud (SESCS), Tenerife, España; Fundación Canaria de Investigación Sanitaria (FUNCANIS), Tenerife, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, España
| | - S García-Pérez
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Agencia de Evaluación de Tecnologías Sanitarias, Instituto de Salud Carlos III, Madrid, España
| | - P Serrano-Aguilar
- Servicio de Evaluación, Servicio Canario de la Salud (SESCS), Tenerife, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, España.
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Ziemssen F, Bartz-Schmidt KU, Dimopoulos S. Knowledge of vitreomacular traction (VMT) scenarios: Is doing nothing still a beneficial alternative and, if so, when? Graefes Arch Clin Exp Ophthalmol 2016; 254:615-6. [PMID: 26887826 DOI: 10.1007/s00417-016-3301-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 12/17/2015] [Indexed: 11/25/2022] Open
Affiliation(s)
- Focke Ziemssen
- Centre for Ophthalmology, Eberhard-Karls-University, Schleichstr. 12, 72076, Tuebingen, Germany.
| | | | - Spyros Dimopoulos
- Centre for Ophthalmology, Eberhard-Karls-University, Schleichstr. 12, 72076, Tuebingen, Germany
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25
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Gómez-Ulla F, Bande MF, Abraldes M. Acute loss of vision after an intravitreal injection ocriplasmin: a functional evolutionary study for 1-year follow-up. Doc Ophthalmol 2015; 131:231-5. [PMID: 26542118 DOI: 10.1007/s10633-015-9517-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Ocriplasmin is a human plasmin fragment indicated for vitreomacular traction treatment. With its increasing use, several reported cases have suggested possible toxicity to the retina. CASE We describe a case of a 55-year-old woman with symptomatic vitreomacular traction and a macular hole in the right eye who showed an acute decrease in visual acuity after an intravitreal ocriplasmin injection. Spectral-domain optical coherence tomography showed an alteration in the ellipsoid layer. Significant retinal vessel constriction was observed by angiography. The visual acuity improved to 20/100, and the electroretinogram progressively improved after the 1-year follow-up and following pars plana vitrectomy. CONCLUSIONS A decrease in visual acuity and an enlargement of the macular hole were observed while studying this patient. This study shows the recovery of adverse effects caused by intravitreal injection of ocriplasmin for 1-year follow-up.
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Chin EK, Almeida DRP, Sohn EH, Boldt HC, Mahajan VB, Gehrs KM, Russell SR, Folk JC. Incomplete vitreomacular traction release using intravitreal ocriplasmin. Case Rep Ophthalmol 2014; 5:455-62. [PMID: 25606039 PMCID: PMC4296250 DOI: 10.1159/000370024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Purpose To report the clinical course of our first 7 consecutive patients treated with intravitreal ocriplasmin (Jetrea®). Methods Retrospective case series of the first 7 patients treated with ocriplasmin between January and December 2013 at an academic tertiary care center. Results The average age was 78.4 years (range: 63–92). Five patients were pseudophakic and 2 patients were phakic in the injected eye. The median baseline visual acuity (VA) was 20/60 (range: 20/25 to 20/200). The median 1-month postinjection VA was 20/70, with a mean loss of 2 lines of VA among all patients. None of the patients had complete resolution of their vitreomacular traction or macular hole at 1 month of follow-up. Three patients had subsequent pars plana vitrectomy and membrane peeling surgery. The mean follow-up period for those who did not undergo vitrectomy was 9 months (range: 1–13). One patient with known ocular hypertension had an increase in intraocular pressure requiring topical pressure-lowering eyedrops. There were no cases of postinjection uveitis, endophthalmitis, retinal tears, or retinal detachment. Conclusions While ocriplasmin may be a viable pharmacological agent for vitreolysis, we present a series of patients that all had incomplete resolution of vitreomacular traction with and without full-thickness macular hole. There was an associated reduction in VA after ocriplasmin treatment at 1 month of follow-up. Careful analysis of the vitreoretinal interface and comorbid eye conditions is required to optimize outcome success with ocriplasmin.
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Affiliation(s)
- Eric K Chin
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - David R P Almeida
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Elliott H Sohn
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - H Culver Boldt
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Vinit B Mahajan
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Karen M Gehrs
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Stephen R Russell
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - James C Folk
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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