title: Acute panretinal structural and functional abnormalities after intravitreous ocriplasmin injection.
abstract: IMPORTANCE Ocriplasmin cleaves fibronectin and laminin, components of the vitreous gel, and is used as a pharmacologic treatment for vitreomacular traction. Laminin is also found throughout multiple retinal layers. Ocriplasmin injection may lead to acute panretinal dysfunction in some eyes, but the mechanism of this toxic reaction has not been described. OBSERVATIONS We evaluated a 63-year-old woman demonstrating acute panretinal dysfunction after intravitreous ocriplasmin injection for a small macular hole with vitreomacular adhesion. Findings included visual acuity loss, visual field constriction, pupillary abnormalities, attenuated retinal arteries, loss of outer retinal signals on spectral-domain optical coherence tomography, and severely reduced electroretinography responses. B-waves were reduced more than A-waves were, suggesting postreceptoral dysfunction and decreased photoreceptor activity. CONCLUSIONS AND RELEVANCE Retinal dysfunction associated with intravitreous ocriplasmin injection is not limited to the macular region and seems to involve the entire retina. Enzymatic cleavage of intraretinal laminin is a biologically plausible mechanism for acute ocriplasmin retinal toxic effects.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.
authors.forename: Abigail T
authors.initials: AT
authors.lastname: Fahim
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.
authors.forename: Naheed W
authors.initials: NW
authors.lastname: Khan
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Johnson
mesh_terms: D000208:Acute Disease; D004596:Electroretinography; D005128:Eye Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D005341:Fibrinolysin / Q000009:adverse effects*; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006801:Humans; D058449:Intravitreal Injections; D008875:Middle Aged; D010446:Peptide Fragments / Q000009:adverse effects*; D012164:Retinal Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D012167:Retinal Perforations / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000188:drug therapy; D041623:Tomography, Optical Coherence; D014786:Vision Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D014792:Visual Acuity / Q000187:drug effects; D014822:Vitreous Body / Q000187:drug effects
chemical_list: D005343:Fibrinolytic Agents; D010446:Peptide Fragments; C054561:microplasmin; D005341:Fibrinolysin