September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Acute Ocriplasmin Retinopathy (AOR): Electroretinographic (ERG), SD-OCT and clinical features of 6-months monitoring
Author Affiliations & Notes
  • Katerina Hufendiek
    University Eye Hospital, Medical School Hannover, Hannover, Germany., Hannover, Germany
  • Karsten Hufendiek
    University Eye Hospital, Medical School Hannover, Hannover, Germany., Hannover, Germany
  • Jan Hendrik Brahms
    University Eye Hospital, Medical School Hannover, Hannover, Germany., Hannover, Germany
  • Anna Bajor
    University Eye Hospital, Medical School Hannover, Hannover, Germany., Hannover, Germany
  • Carsten Framme
    University Eye Hospital, Medical School Hannover, Hannover, Germany., Hannover, Germany
  • Footnotes
    Commercial Relationships   Katerina Hufendiek, None; Karsten Hufendiek, None; Jan Hendrik Brahms, None; Anna Bajor, None; Carsten Framme, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 4048. doi:
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      Katerina Hufendiek, Karsten Hufendiek, Jan Hendrik Brahms, Anna Bajor, Carsten Framme; Acute Ocriplasmin Retinopathy (AOR): Electroretinographic (ERG), SD-OCT and clinical features of 6-months monitoring. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4048.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To report ERG, SD-OCT and clinical features of 6-months monitoring a patient with AOR

Methods : Recently few reports notified visual acuity (VA) loss, dyschromatopsia, visual field (VF) constriction, pupillary abnormalities, loss of outer retinal signals on OCT and reduced ERG responses after intravitreal ocriplasmin injection. Safety profile of the registration trial (Phase 3 MIVI-III) suggested adverse events (AE) to be related to injection procedure and vitreolysis, explaining loss of VA with subretinal serous fluid accumulation (median recovery to baseline within 2 weeks, resolution of dyschromatopsias within 3 months). We present a course of AOR over 6 months with severe changes in function (VA, VF, ERG) and retinal structure.

Results : A 74-year-old woman presented to our clinic with loss of VA to hand motion, shimmering photopsias, floaters and dyschromatopsia in the right eye one day after intravitreal injection of Ocriplasmin for vitreomacular traction (VMT). Preoperative VA was 0.32 Snellen chart in the treated eye. On day 1, SD-OCT showed resolution of the VMT, but new neurosensory serous retinal detachment (NSD). Outer retinal layers (ORL) showed severe disruption of the ellipsoid zone, which partially recovered with VA improvement to baseline at week 5 and to 0.5 at month 6. At week 5 and month 6 NSD had resolved, the ellipsoid zone showed structural recovery. VF testing (Goldmann) at day 1 showed severe constriction of all isopters which gradually recovered by week 5, but central relative scotoma persisted by month 6 (Fig.1). Full-field ERG initially showed severe reduction of scotopic and photopic responses and an electronegative ERG, suggesting postreceptoral dysfunction and decreased photoreceptor activity (Fig.2).

Conclusions : In our patient AOR lead to severe VA loss and dyschromatopsia, the recovery of which took longer than described in the registration trial (MIVI-III). Severe VF constriction and loss of full-field ERG responses showed a generalized retinopathy not mentioned as AE in the trial. Animal studies relate the acute toxic effect to the separation and disruption of laminin and fibronectin in the ORL. Further studies are necessary to fully understand the impact of ocriplasmin on long term visual outcome. Postoperative monitoring of VF and in cases with severe visual loss ERG is recommended.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

 

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