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Eric Nudleman, Alan J Ruby, Jeremy Wolfe; Ocriplasmin for Vitreomacular Adhesion: Aftermarket Experience and Findings. Invest. Ophthalmol. Vis. Sci. 2014;55(13):301.
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© ARVO (1962-2015); The Authors (2016-present)
We aimed to identify morphologic criteria to help select appropriate patients for treatment with Ocriplasmin and describe the morphologic changes after VMA release.
This is a retrospective review of patients treated with Ocriplasmin for symptomatic VMA at a single center between February 2013 and September 2013. The primary end point was release of VMA at one month post-injection. Additional endpoints included VMA release by adhesion size, presence of subretinal fluid (SRF) after release of adhesion, size of SRF at 1 week and 1 month, outer retinal structural change, visual acuity, and closure of macular hole.
Thirty seven patients met inclusion criteria. Twenty seven eyes had symptomatic VMA and 10 eyes had stage 2-3 macular holes. Sixteen eyes (43%) had complete separation at 1 month. Ten eyes had macular holes at presentation, of which 9 eyes (90%) separated and seven eyes (70%) had closure at 1 month. Epiretinal membrane was present in 2 of 16 eyes (12.5%) that separated, and 10 of 21 eyes (48%) that failed to separate. Average adhesion size was 277 μm (55 μm - 668 μm) in eyes with separation and 657 μm (288 μm - 2994 μm) in eyes that failed. An average vision improvement of -0.19 logMAR was seen in patients that separated, whereas an average vision change of +0.016 logMAR was seen in patients that did not separate. SRF was present following separation in 11 eyes (69%), and persisted through 1 month in 9 eyes (56%). Between 1 week and 1 month follow-up, the average SRF height decreased by 54% and the average SRF basal diameter decreased by 56%. Changes in the IS/OS junction were present in 20 eyes (54%) at 1 week, 15 eyes (40%) at 1 month, and 6 eyes (16%) at last follow-up. The IS/OS changes were equal in eyes that separated and did not separate.
Separation of VMA following treatment with Ocriplasmin occurred in 43% of treated eyes. The rate of separation was increased in patients with smaller adhesions without an epiretinal membrane. SRF was present in the majority of patients following separation, but it was reduced by half at 1 month follow-up. Changes in IS/OS junction following treatment were seen in roughly half of patients, but these changes resolved in most patients at final follow-up.
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