[Initial clinical experience in the treatment of vitreomacular traction and macular holes with ocriplasmin].
BACKGROUND
The introduction and approval of Ocriplasmin as an intravitreally applicable drug in the pharmocological treatment of vitreomacular traction represents a new therapeutic approach possibly avoiding vitreoretinal surgery. With our article we report our first experience wih Ocriplasmin in clinical practice.


METHODS
The indication for intravitreal therapy with Ocriplasmin was provided for symptomatic VMT or macular hole with VMT in 20 patients since March 2013. Surgery was planned in cases with remaining symptoms. Before IVI we performed SD-OCT. Best visual acuity (BCVA) was evaluated preoperatively, 7 and 28 days after treatment and finally every month in 14 treated eyes. SD-OCT images were analysed before treatment and later on with every follow-up examination. In addition to functional and morphological changes we analysed all side effects.


RESULTS
The mean BCVA at the beginning of treatment was 0.3 and 0.4 before injection. The indications for treatment were as follows: symptomatic VMT in 10 patients and 4 patients suffering from full thickness macular hole stage 2. In 3 patients spontaneous regression of VMT could be observed with increasing of vision from 0.3 to 0.5. In one patient his macular hole was closed and BCVA increased from 0.2 to 0.6 within 7 days. Two patients showed significant enlargement of their macular holes after 7 days and finally underwent surgery. A massive cystoid macular oedema occurred in one patient. No change in the SD-OCT image could be observed 28 days after treatment. The mean visual acuity improved to 0.6 during a follow-up period of 90 days. Photopsia and disturbing vitreous opacities up to 28 days post injection could be regarded as minor side effects.


CONCLUSIONS
Our first clinical experience with intravitreous injection of Ocriplasmin were performed to confirm the presumed therapeutic effect in patients suffering from VMT. Small macular holes could frequently be closed. The possibility of special side effects must be taken in consideration just as the possibility of spanteous improvement before performing IVI with Ocriplasmin. Further prospective studies must be recommended to be right about Ocriplasmin injections.
St. Franziskus Hospital, Augenabteilung, Münster.
A P
AP
Lommatzsch
St. Franziskus Hospital, Augenabteilung, Münster.
M
M
Gutfleisch
St. Franziskus Hospital, Augenabteilung, Münster.
M
M
Dietzel
St. Franziskus Hospital, Augenabteilung, Münster.
B
B
Heimes
St. Franziskus Hospital, Augenabteilung, Münster.
G
G
Spital
Universität Essen-Duisburg, Universitätsaugenklinik, Essen.
M
M
Böhme
Universität Essen-Duisburg, Universitätsaugenklinik, Essen.
N
N
Bornfeld
St. Franziskus Hospital, Augenabteilung, Münster.
D
D
Pauleikhoff
D005341:Fibrinolysin / Q000008:administration & dosage*; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D058449:Intravitreal Injections; D010446:Peptide Fragments / Q000008:administration & dosage*; D010865:Pilot Projects; D012167:Retinal Perforations / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*; D000267:Tissue Adhesions / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D016896:Treatment Outcome; D020255:Vitreous Detachment / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*
D005343:Fibrinolytic Agents; D010446:Peptide Fragments; C054561:microplasmin; D005341:Fibrinolysin