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Nathan Steinle, Dilsher Dhoot, Carlos Quezada, Ma'an A Nasir, Dante Joseph Pieramici, Robert See, Steve Couvillion, Alessandro Castellarin, Robert L Avery; Intravitreal Perfluoropropane Gas (C3F8) Versus Ocriplasmin for Vitreomacular Traction (VMT). Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3515.
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Currently there are three mainstream approaches to the management of VMT: observation, intravitreal ocriplasmin (IVO), and surgical intervention (pars plana vitrectomy). Intravitreal C3F8 gas injection (i.e., pneumatic vitreolysis) may prove to be an inexpensive, safe, and reliable method of obtaining therapeutic release of symptomatic vitreomacular adhesions and may offer another non-surgical option for patients that had previous ocriplasmin and/or concurrent epiretinal membrane (ERM) or diabetes mellitus (DM).
Consecutive VMT patients treated with ocriplasmin or C3F8 injection were retrospectively reviewed. VMT release rates, visual acuity (VA), and outer retinal band (ORB) changes on SD-OCT were compared. C3F8 injection patients included eyes with diabetes mellitus, epiretinal membrane, as well as eyes with previous ocriplasmin use. Standard IVO dosing and injection technique was used in the ocriplasmin study group. Up to 0.3 cc of 100% C3F8 gas was injected in an office setting in the C3F8 study group.
Number of included eyes was 55 (n=55, 23 received ocriplasmin, 32 received C3F8). VMT release rate was 48%(11/23) with ocriplasmin and 84%(27/32) with C3F8, p<0.05. 4 of 5 patients with past failed ocriplasmin released with C3F8. 5 of 6 eyes with concurrent ERM released with C3F8. 8 of 9 eyes with concurrent DM released with C3F8. VA improved slightly in both groups. No long-term pressure changes were noted with C3F8, although one patient had an acute pressure spike after gas injection. ORB changes on SD-OCT were noted in 10/23 with IVO and 1/32 with C3F8, p<0.05.
Office-based intravitreal C3F8 gas injection showed a VMT release rate of 84% with minimal ORB changes on SD-OCT. C3F8 gas was also effective in failed IVO patients as well as patients with DM or ERM. Despite ideal case selection for IVO administration, pharmacologic vitreolysis with IVO revealed a success rate less than C3F8, and IVO showed significant ORB changes on SD-OCT. Thus, C3F8 intravitreal injection appeared to be a safe, inexpensive, and effective option for the treatment of VMT, including patients who had previous ocriplasmin administration and in patients with concurrent vitreoretinal interface pathology (including DM or ERM).
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