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Henry L Feng, Daniel B Roth, Kunjal K Modi, Howard F Fine, Harold M Wheatley; Complications of Intravitreal Ocriplasmin in the Treatment of Symptomatic Vitreomacular Adhesion. Invest. Ophthalmol. Vis. Sci. 2014;55(13):308.
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Ocriplasmin is a proteolytic enzyme approved for treatment of symptomatic vitreomacular adhesion (VMA). Our study evaluates the features of our initial series of eyes treated with intravitreal ocriplasmin in order to determine potential complications with this agent.
Retrospective review of 62 eyes with symptomatic VMA associated with vision loss and anatomic macular distortion. Each eye was treated with a pars plana injection of ocriplasmin (125mcg in 0.1cc) and assessed at 1 week and 1 month post-injection using OCT, with added follow-up in complicated cases. Associated conditions included macular hole (MH), cystoid macular edema, diabetic macular edema, myopic schisis, epiretinal membrane, and dry AMD.
Initial enlargement in MH width after injection occurred in 54% of MH eyes. 100% of eyes with MH enlargement required surgical MH closure vs. 27% in those without MH enlargement (p=0.001). In MH-enlarged eyes, best visual acuity (VA) attained within 8 months post-surgery was significantly lower than that attained by non-MH-enlarged eyes within 8 months post-injection (p=0.001, mean VA 20/112 vs. 20/34). MH enlargement was not associated with differences in age, pre-injection VA, VMA width, or MH width (p=0.82, 0.43, 0.21, 0.69). Subretinal fluid (SRF) developed after injection in 37% of eyes without initial SRF. In this subset, SRF resolved surgically in 35% and spontaneously in 35%, but 30% remained unresolved over a mean follow-up of 5 months. Eyes with spontaneous SRF resolution resolved over a range of 1 to 4 months with a mean of 2 months. However, there was no difference between SRF eyes and non-SRF eyes in VA at 1 week (p=0.11) or best VA over 8 months follow-up (p=0.24). No eyes in our series experienced new ellipsoid layer disruption. Subjective visual worsening was reported during the initial 2 days after injection in 43% of eyes, with objective VA decline in 20% and 33% at 1 week and 6 weeks, respectively. Photopsia and dyschromatopsia was reported in 48% and 15% of eyes, respectively.
Ocriplasmin may effectively achieve vitreomacular separation in eyes with symptomatic VMA. However, MH enlargement and SRF development may increase the likelihood of requiring surgical intervention and negatively impact VA. An understanding of potential complications and appropriate patient expectations are vital in the management of symptomatic VMA with ocriplasmin.
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