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Daniel B Roth, Henry L Feng, Kunjal K Modi, Howard F Fine, Harold M Wheatley; Predictors of Success with Intravitreal Ocriplasmin in the Treatment of Symptomatic Vitreomacular Adhesion. Invest. Ophthalmol. Vis. Sci. 2014;55(13):298.
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© ARVO (1962-2015); The Authors (2016-present)
Ocriplasmin is a proteolytic enzyme that is approved for the treatment of symptomatic vitreomacular adhesion (VMA). Our study investigates the characteristics of our initial series of eyes treated with intravitreal ocriplasmin in order to determine predictors of success with this pharmacologic agent.
Retrospective review of 62 eyes with symptomatic VMA associated with vision loss and anatomic distortion of the macula. Each eye was treated with a single pars plana injection of ocriplasmin (125mcg in 0.1cc) then assessed at 1 week and 1 month with OCT. Associated conditions included macular hole (MH), cystoid macular edema (CME), myopic schisis, epiretinal membrane (ERM), dry AMD, and diabetic macular edema (DME).
Ocriplasmin induced VMA resolution in 41% of all cases. 26% experienced VMA release if other macular disease was also present vs. 59% if no other disease present (p=0.01), and successful in only 20% of eyes with ERM, 12.5% with dry AMD, and 20% with DME. Patients ≤age 75 were 3.2 times more likely to achieve VMA release (p=0.004). 51% released if VMA diameter was <750μm vs. 14% if diameter ≥750μm (p=0.002), and for every additional 100μm there was a 20% increased likelihood of VMA not releasing. VMA release occurred in 23% of pseudophakic eyes vs. 51% in phakic eyes (p=0.02). VMA release occurred in 69% of eyes with MH vs. 16% of non-MH eyes (p<0.001). However, 40% of MH eyes required surgical closure despite VMA release. Nonsurgical MH closure was associated with better pre-injection VA (p=0.014). Mean VMA diameter was smaller in MH eyes that closed pharmacologically (341μm vs. 723μm). Closure was not associated with MH diameter, but most eyes in this cohort had smaller MHs. Factors that did not predict VMA release included photopsia, dyschromatopsia, subjective visual loss, pre-treatment VA, decreased VA at one week, presence of DM, presence of CME, and prior treatments.
Ocriplasmin may effectively accomplish vitreomacular separation in eyes that have pathology associated with vitreomacular traction. Features that may predict success include younger age, smaller VMA diameter, phakia, and absence of other macular pathology. In addition, better pre-injection VA and smaller VMA diameter may predict nonsurgical MH closure. Proper case selection is imperative for optimizing success in the pharmacologic management of symptomatic VMA with ocriplasmin.
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