Abstract
Purpose :
Ocriplasmin (OCP) is an enzymatic vitreolysis for symptomatic vitreomacular traction (VMT). Initial trials of OCP yielded tepid results; however, post hoc analysis has provided positive predictive factors for successful outcomes, including age <65 years, phakic eyes, adhesion diameter <1500 microns, and absence of epiretinal membrane (ERM). Continued refinement of positive predictive factors helps to identify optimal patients for OCP treatment. This retrospective case series describes novel positive predictive factors in treating symptomatic VMT.
Methods :
This retrospective case series included 11 patients diagnosed with symptomatic VMT and treated with OCP at the University of Florida from 1/1/2015 to 7/1/2020 regardless of their phakic status, presence of ERM, age, or initial visual acuity (VA). Patients were excluded from receiving OCP treatment if they were aphakic, had >8 diopters of myopia or an axial length >28mm, vitreous opacity obscuring posterior pole visualization, diffuse VMT (>1500 microns), stage 2 or greater macular hole, or other concurrent retinal diseases. The de-identified data was then collected and analyzed using Z-test statistical analysis. The primary outcome measured was the resolution of VMT as defined by optical coherence tomography (OCT).
Results :
Of the 11 patients treated with Ocriplasmin, 63.6% had resolution of their VMT. Subgroup analysis was conducted for initial visual acuity and adhesion diameter, as measured by OCT. Patients whose initial VA was ≤ 20/50 all had resolution of their VMT and did significantly better compared to initial VA of ≥ 20/60 among all patients (p=0.011) and when controlling for ERM (p=0.037). In subgroup analysis of micro (<500 microns) versus focal VMT (500-1500 microns), micro VMT trended towards greater resolution, 85.7% vs 50%, respectively (p=0.142) [Figure 1].
Conclusions :
The continued refinement of positive predictor factors is paramount to improving the efficacy of OCP and its cost-effectiveness. The greater resolution rate in micro VMT was not statistically significant in this small case series but warrants further investigation. OCP may have greater efficacy in patients with symptomatic VMT with VA ≤ 20/50, which may impact useful clinical practice with earlier treatments.
This is a 2021 ARVO Annual Meeting abstract.