Abstract
Purpose:
Intravitreal injections of Ocriplasmin have recently been used to treat vitreo-macular traction (VMT). Some have reported associated transient dyschromatopsias and fewer have reported ERG abnormalities. We reviewed our experience with Ocriplasmin including ERG and OCT findings before and after the injection.
Methods:
A retrospective chart review was conducted of our first nine consecutive patients who were treated with intravitreal Ocriplasmin. Pre-injection and post injection data collected were visual acuity, funduscopy, fundus photographs, OCT and IVFA findings. Retinal function was evaluated using ISEV standardized full field ERG testing and when appropriate, visual evoked potential (VEP). IRB approval was obtained.
Results:
Three of the nine patients had successful release of the vitreo-macular traction but only two of these three patients achieved closure of the macular hole with visual acuity improvement (20/400 to 20/30; 20/80 to 20/30). Patient 1 had moderate rod and cone function loss and patient 2 had severe loss of rod function by ERG. Patient 3 experienced successful release of the vitreo-macular traction but the macular hole did not close. Patient 3 still experienced a significant loss in rod and cone function. These three also showed a disappearance of the ellipsoid layer. Changes in patient 1, 2 and 3 persisted for over 6 months with minimal recovery of cone and rod function. In patient 1, ERG recordings improved dramatically along with the reappearance of the ellipsoid layer on OCT but only after 15 months. However, her ERG has not returned to baseline. In patients 2 and 3, the ERG and ellipsoid layer recovered after 6 months. The six remaining patients experienced no change in visual acuity, ERG or OCT and all 6 had subsequent successful vitrectomy with hole closure and improvement in visual acuity.
Conclusions:
Ocriplasmin caused vitreo-macular traction release and significant ERG depression along with loss of ellipsoid layer in 3 of 9 patients; 2 of the 3 patients had successful macular hole closure with visual acuity improvement. The OCT ellipsoid layer loss paralleled the ERG depression. We found no ERG changes in the patients following vitrectomy and membrane peel with indocyanine green. This is one of the first reports of chronic ERG changes due to Ocriplasmin.