title: The Plane of Vitreoretinal Separation and Results of Vitrectomy Surgery in Patients Given Ocriplasmin for Idiopathic Macular Hole.
abstract: OBJECTIVE
  We assessed whether ocriplasmin (OCP) given to patients with idiopathic macular hole (IMH) results in an altered plane of vitreoretinal (VR) separation compared to patients without OCP exposure.
  
  
  METHODS
  A prospective study was done of 12 patients with IMH and vitreomacular adhesion (VMA) given OCP. Patients in whom the IMH failed to close underwent vitrectomy with peeling of the internal limiting membrane (ILM). The intraoperative staining pattern of the ILM using Brilliant Blue G (BBG) and examination of the excised ILM with transmission electron microscopy (TEM) were compared to results of a matched cohort of 31 patients with IMH who had not received OCP.
  
  
  RESULTS
  Among 12 patients treated with OCP, VMA release occurred in 7 (58%) and hole closure was achieved in 3 (25%). Vitrectomy was done on the nine patients without hole closure. In seven of these nine (78%) the ILM had less than 5% of its vitreous surface covered in residual material on TEM, which was significantly less than in the control group (5/31, 16%, P = 0.001). In two OCP patients, large amounts of vitreous side material were present, but the rim of the hole stained evenly with BBG, suggesting that epiretinal material had avulsed with VR separation, a pattern not seen in any of the control patients. All patients had IMH closure after vitrectomy and visual results were not significantly different from the control group.
  
  
  CONCLUSIONS
  Ocriplasmin facilitates more complete VR separation in patients undergoing surgery for IMH, although it does not result in more eccentric epiretinal tissue release.
authors.affiliation: Sunderland Eye Infirmary Queen Alexandra Road, Sunderland, United Kingdom 2Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom.
authors.forename: David H W
authors.initials: DH
authors.lastname: Steel
authors.affiliation: Sunderland Eye Infirmary Queen Alexandra Road, Sunderland, United Kingdom.
authors.forename: Maria T
authors.initials: MT
authors.lastname: Sandinha
authors.affiliation: EM Research Services, Newcastle University, Newcastle Upon Tyne, United Kingdom.
authors.forename: Kathryn
authors.initials: K
authors.lastname: White
mesh_terms: D000368:Aged; D001485:Basement Membrane / Q000601:surgery; D016022:Case-Control Studies; D019773:Epiretinal Membrane / Q000601:surgery; D005260:Female; D005341:Fibrinolysin / Q000627:therapeutic use*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D010446:Peptide Fragments / Q000627:therapeutic use*; D011446:Prospective Studies; D012167:Retinal Perforations / Q000628:therapy*; D012394:Rosaniline Dyes; D014821:Vitrectomy / Q000379:methods*
chemical_list: D005343:Fibrinolytic Agents; D010446:Peptide Fragments; D012394:Rosaniline Dyes; C054561:microplasmin; D005341:Fibrinolysin; C004692:coomassie Brilliant Blue