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Andrew Coskey, David M Brown, Claudia Hooten, Leslie K Kao, Charles Clifton Wykoff, James C Major, Amy C Schefler; Ocriplasmin for Vitreomacular Adhesion (VMA) in the Clinical Setting: Rates of VMA Release, Development of Macular Holes, and Visual Outcomes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):291.
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To evaluate the rate of resolution of symptomatic vitreomacular adhesion (VMA) after a single intravitreal injection of ocriplasmin.
This was a retrospective review of all patients treated with ocriplasimin in a nine-month period immediately after the FDA approval of the drug (Jan 2013-Sep 2013) at a large, multi-site retina practice. Clinical data collected and assessed included anatomic success, pre- and post-injection visual acuity, need for vitrectomy, and adverse visual effects.
Fifty-two patients underwent treatment. At baseline, all patients had VMA, two patients (3.8%) had mild epiretinal membranes and 22 patients (42.3%) had evolving or small macular holes. Twenty-four patients (46.2%) demonstrated resolution of VMA by OCT. Mean initial LogMAR scores of patients whose hyaloid released was 0.469 with a gain of 0.335 post treatment. Eighteen patients (34.6%) had no anatomic change. Thirteen patients (25%) had worsening of anatomy and/or vision that required vitrectomy including five patients (9.6%) who developed a full thickness macular hole. There was an 18.2% closure rate in the group of patients that presented with macular holes. This group had initial and final LogMAR scores of 0.872 and 0.662, respectively. Three patients whose vision worsened reported an overall decrease/darkening of their vision, one of whom had a confirmed severe decrease in the combined response on a full field ERG. Overall, patients’ vision improved from a LogMAR score of 0.629 pre-treatment to a score of 0.531 post-treatment.
This is the largest series examining the use of ocriplasmin in a clinical setting since the MIVI-TRUST trial. Despite the fact that some patients did not meet the strict criteria for entry into MIVI-TRUST, we still observed a 46% rate of anatomic resolution of VMA. One quarter of patients still require vitrectomy and severe ERG changes can occur.
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