Clinical results of Ocriplasmin versus C₃F₈ gas for symptomatic Vitreomacular Traction Syndrome

Abstract

Purpose : Until recently, vitrectomy surgery was the preferred treatment for vitreomacular traction (VMT), but due to its potential complications, it is normally only performed once there is clinically significant loss of vision. It can also be costly and invasive for patients. As an alternative, intravitreal therapy can be used – ocriplasmin (Jetrea®) has recently been licenced for use in VMT and small macular holes, but is costly, and intravitreal gas injection can also be used. The purpose of this retrospective comparative case review is to evaluate the resolution rate of VMT after receiving either ocriplasmin or Perfluoropropane (C₃F₈ gas).

Methods : This review retrospectively analysed 20 medical records from patients with diagnosed VMT using spectral-domain optical coherence tomography (sdOCT) that underwent intravitreal injections of either Jetrea (n=10) or C₃F₈ gas (n=10). All treatments were administered by the same surgeon. Patients either received 0.125 mg of Jetrea as per the package guidelines or an injection of 0.3 mL of C₃F₈ gas. The primary outcome measure was release of VMT on sdOCT at one month after treatment. Secondary outcomes included central subfield thickness after treatment, change in visual acuity and any side effects/complications.

Results : 50% had resolution of vitreomacular traction on sdOCT by one month after Jetrea injection compared to 80% of patients treated with C₃F₈ gas. Mean visual acuity at one month improved by a mean of +10.3 letters following ocriplasmin compared to only +0.4 letters after C₃F₈ gas, probably representing persistence of the gas bubble. Consistent with this, central subfield thickness on sdOCT decreased by an average of 39 microns after injection in patients that received gas compared to only 4.9 microns in the group of patients that received ocriplasmin. No patients developed retinal tears or detachment.

Conclusions : C₃F₈ gas proved to be of similar effectiveness to Ocriplasmin in our small study, providing effective release of VMT. This study suggests that C₃F₈ gas could provide a cost effective and readily available alternative treatment for patients and that a larger prospective trial would be worthwhile to establish its use in the standard treatment pathway for VMT.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.