Real-life experience after intravitreal ocriplasmin for vitreomacular traction and macular hole: a spectral-domain optical coherence tomography prospective study.
OBJECTIVE
To evaluate prospectively the anatomical and functional results after ocriplasmin injection in patients with vitreomacular traction (VMT), or macular hole (MH) combined with VMT, providing the real-life experience of three centers, using spectral domain-optical coherence tomography (SD-OCT).


METHODS
Twenty-four patients with VMT (17 with VMT alone and 7 with an MH combined with VMT) were treated with a single ocriplasmin injection and followed-up prospectively at baseline, day 1, 7, 28 and the last examination of the follow-up for each patient (range: 30-127 days). Best-corrected visual acuity (BCVA) and SD-OCT were performed for patient assessment, while various adverse events were recorded and analysed. At baseline, univariate analysis was also performed to examine the potential predictive factors for VMT release.


RESULTS
66.7 % of patients presented VMT release at the end of the follow-up, while 28.6 % exhibited MH closure. Baseline positive predictive factors for VMT release were young age, being female, phakic lens status, increased vitreofoveal angle, V-shaped and loose vitreomacular adhesion, small adhesion area, thin vitreous strands at the adhesion site and absence of an epiretinal membrane. Four new cases of ellipsoid line changes and subretinal fluid development became evident at day 7 compared to baseline. Lamellar macular hole (LMH) in four cases was first noticed at day 28 post injection. Formation of cystoid macular edema (CME) was noticed in three new cases at day 28 compared to baseline.


CONCLUSIONS
Our study demonstrated a VMT release rate of 66.7 %. Apart from the known baseline factors that influence VMT release after ocriplasmin injection, the size of the vitreofoveal angle, a V-shaped and loose vitreomacular adhesion, a small adhesion area, and thin vitreous strands at the adhesion site, could additionally affect the outcome of VMT release. In addition, we studied when VMT release and concomitant events occur and for how long the induced complications lasted.
2nd Department of Ophthalmology, Ophthalmiatrion Athinon, Athens, Greece.
Irini
I
Chatziralli
2nd Department of Ophthalmology, Henry Dunant Hospital, Athens, Greece. theodossiadisg@ath.forthnet.gr.|, 13 Lykiou street, 10674, Athens, Greece. theodossiadisg@ath.forthnet.gr.
George
G
Theodossiadis
2nd Department of Ophthalmology, Ophthalmiatrion Athinon, Athens, Greece.
Efstratios
E
Parikakis
Ophthalmological Institute of Athens, Athens, Greece.
Ioannis
I
Datseris
2nd Department of Ophthalmology, University of Athens, Attikon Hospital, Athens, Greece.
Panagiotis
P
Theodossiadis
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005341:Fibrinolysin / Q000627:therapeutic use*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000627:therapeutic use*; D011446:Prospective Studies; D012160:Retina / Q000187:drug effects* / Q000503:physiopathology; D012167:Retinal Perforations / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D000267:Tissue Adhesions / Q000188:drug therapy; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D020255:Vitreous Detachment / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
D005343:Fibrinolytic Agents; D010446:Peptide Fragments; C054561:microplasmin; D005341:Fibrinolysin
Macular hole; Ocriplasmin; Spectral-domain optical coherence tomography; Vitreomacular traction