Intravitreal Ocriplasmin for Symptomatic Vitreomacular Adhesion

Abstract

 

Purpose

 

To determine the efficacy of a single intravitreal ocriplasmin injection to relieve symptomatic vitreomacular adhesion (VMA).

 

Methods

 

This is a retrospective case review of 35 patients with symptomatic VMA who received intravitreal ocriplasmin injection at the Retina Group of Washington between February 2013 and November 2013. Extracted data included patient demographics, lens status, medical and ocular comorbidities, VMA size and duration, presence of epiretinal membrane (ERM), FTMH, cystoid macular edema (CME), posterior vitreous detachment (PVD), and optical coherence tomography (OCT) ellipsoid zone changes, FTMH size, best corrected visual acuity (BCVA), follow up, surgery, and complications. Primary endpoints included release of VMA and closure of FTMH. Secondary endpoints included rate of PVD induction and ellipsoid zone changes, change in BCVA, time to VMA release, and complications.

 

Results

 

The mean subject age was 69.4 years, and 23 (66%) patients were female. 25 (71%) subjects were phakic, and 10 (29%) were pseudophakic. Nine subjects (26%) had retinal comorbidities. Mean VMA diameter was 571 micrometers, with average duration of 7.9 months prior to injection; 25 (71%) had associated CME, 9 (26%) had ERM, and 6 (17%) had FTMH, of mean size 186 microns. Mean pre-injection BCVA was 20/57 (0.46 LogMAR) and final BCVA was 20/43 (0.33 LogMAR). VMA release occurred in 15 (43%) subjects after a mean 10.2 days after injection, with complete PVD noted in 12. Mean VMA diameter (p = 0.005) and duration (p = 0.03), absence of retinal comorbidities (p = 0.02), and mean age (p = 0.04) were predictive of VMA release. FTMH closure occurred in 1 of 6 cases (17%). Ellipsoid zone changes were seen in 10 (29%) patients. Eight (23%) subjects underwent surgery. Two (6%) patients had complications - one retinal detachment and one intraocular pressure spike. Mean follow up was 96 days.

 

Conclusions

 

Intravitreal ocriplasmin may be a reasonable treatment option for patients with symptomatic VMA, and may be particularly useful in VMA of limited size and duration.

 

 

Spectral domain optical coherence tomography (OCT) image prior to ocriplasmin injection of a 51 year old woman with a 261 micron vitreomacular adhesion (VMA) and impending full thickness macular hole.

 

 

One week post-injection OCT of the same 51 year old woman, showing complete resolution of her VMA, with persistent subretinal fluid.

 

Keywords: 688 retina • 585 macula/fovea • 503 drug toxicity/drug effects