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Nathan C Steinle, Carlos Quezada, Ma Nasir, Dante Joseph Pieramici, Alessandro Castellarin, Robert F See, Stephen Couvillion, Dilsher Dhoot, Melvin Rabena, Robert L Avery, ; Outer Band Reflectivity Changes on SD-OCT Following Intravitreal Ocriplasmin for Vitreomacular Traction (VMT) and macular holes (MH). Invest. Ophthalmol. Vis. Sci. 2014;55(13):296.
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© ARVO (1962-2015); The Authors (2016-present)
To report initial experience with intravitreal ocriplasmin (IVO) and to describe outer retinal band reflectivity changes observed on spectral domain OCT (SDOCT) following IVO injection in patients with VMT with or without MH.
A consecutive retrospective review of patients with VMT and MH who were treated with IVO was performed. Patients underwent complete ophthalmic evaluation, including non-standardized Snellen visual acuity testing, and SD-OCT at baseline and follow-up visits.
Twenty-four eyes of 24 consecutive patients received IVO for symptomatic VMT. Patients ages ranged from 53 to 93 years with a mean of 73 years. The mean follow-up was 168 days (range 20-291 days), and there were 15 phakic and 9 pseudophakic eyes. VMT release at day 30 after IVO was achieved in 12 out of 24 (50%) patients, at an average of 14 days (1-30 days) after treatment. Eight patients had pre-ocriplasmin MH associated with VMT. Closure of the MH post ocriplasmin was achieved in 2 patients and 6 patients underwent PPV for MH repair. Ten of 24 (42%) patients presented with changes in the outer bands (external limiting membrane and/or IS/OS lines) on SD-OCT after ocriplasmin injection. In 7 of 10 (70%) of these patients, VMT release was noted on OCT by day 30 post-injection compared to 4 of 12 (33%) patients without outer band changes post-IVO. Normalization of the outer band reflectivity was achieved in all cases by the end of follow-up. Mean visual acuity (VA) improved from 0.50 logMar at baseline to 0.37 logMar at the last-follow-up visit. In patients with decreased outer band reflectivity, mean VA improved from 0.45 logMar to 0.23 logMar at the last follow-up. No complications were observed during the injection procedure. Common referred symptoms post IVO were floaters in 12/24 patients, distortion (6/24) and flashes in 5/24. Dyschromatopsia was reported by 2 patients at day 1 post IVO, symptoms improved within 3 weeks. No retinal tears, detachment or endophthalmitis were found after IVO.
In this case series of VMT/MH patients treated with ocriplasmin, changes in the SD-OCT outer retina reflectivity was relatively common. Within weeks the outer retinal reflectivity improved, as did the visual acuity. Further studies to investigate the association between outer band reflectivity changes with the use of IVO and long-term visual acuity are warranted.
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