Reversible vision loss and outer retinal abnormalities after intravitreal ocriplasmin injection.
OBJECTIVE
Ocriplasmin is a truncated form of the human serine protease plasmin, which was recently approved for the nonsurgical treatment of symptomatic vitreomacular adhesions. According to its FDA label, approximately 8% of subjects experienced acute transient vision loss during the first week after injection with no alternative explanation for the change. This report focuses on a recent case of recovered vision loss over a 3-month period after the injection.


METHODS
A comprehensive ophthalmic examination was performed before the injection, during the day of the injection, and at 2 days, 2 weeks, 1 month, and 4 months after the injection. This examination included a full ophthalmic workup and imaging with spectral domain optical coherence tomography. A case of a 55-year-old woman who experienced acute severe vision loss 2 days after the treatment with ocriplasmin was reported.


RESULTS
Distinct alterations, as seen with spectral domain optical coherence tomography, were observed in the ellipsoid zone of photoreceptors. These changes together with patient's visual acuity gradually recovered over a 3-month period after the injection.


CONCLUSIONS
Further investigation may be warranted to fully elucidate the precise molecular mechanisms involved in patients with unexplained vision loss after ocriplasmin injection.
*Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; †The Warren Alpert Medical School, Brown University, Providence, Rhode Island; ‡Retina Service, Division of Ophthalmology, Beth Israel Medical Center, Boston, Massachusetts; and §Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Aristomenis
A
Thanos
Jonathan
J
Hernandez-Siman
Kyle V
KV
Marra
Jorge G
JG
Arroyo
D000208:Acute Disease; 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*; D012075:Remission, Spontaneous; D012164:Retinal Diseases / Q000139:chemically induced*; D014786:Vision Disorders / Q000139:chemically induced*
D005343:Fibrinolytic Agents; D010446:Peptide Fragments; C054561:microplasmin; D005341:Fibrinolysin