title: ELLIPSOID ZONE MAPPING AND OUTER RETINAL CHARACTERIZATION AFTER INTRAVITREAL OCRIPLASMIN.
abstract: OBJECTIVE
  To assess outer retinal architectural alterations after intravitreal ocriplasmin with a novel automated ellipsoid zone (EZ) mapping algorithm.
  
  
  METHODS
  A single-center, retrospective, consecutive case series of image analysis was performed. Quantitative assessment of EZ status imaged with spectral-domain optical coherence tomography was performed before and after single intravitreal injection of 0.125 mg of ocriplasmin (Jetrea, Thrombogenics). A novel EZ mapping algorithm was used to assess the EZ retinal pigment epithelium (RPE) central area, EZ-RPE macular volume, and en face EZ integrity based on the percentage of sampling areas with 20 μm or greater EZ-RPE thickness. Longitudinal assessment of these changes with custom optical coherence tomography reading software was completed. Clinical characteristics and outcomes were compared with these retinal changes.
  
  
  RESULTS
  Nineteen eyes were included in this study. The retinal volume between EZ and RPE was significantly reduced at 1 week after ocriplasmin (P = 0.0036). Seven of 19 patients (36.8%) complained of color abnormalities or brightness reduction after injection. All of these seven patients had increased subretinal fluid after ocriplasmin and EZ attenuation. The EZ-RPE volume was reduced at 1 week (P = 0.0036), 1 month (P = 0.015) after ocriplasmin, and restored by 3 months. The area with EZ-RPE thickness below 20 μm was increased at 1 week (P = 0.046) after ocriplasmin and recovered with time.
  
  
  CONCLUSIONS
  Mapping of EZ is feasible to assess EZ-RPE volume and overall EZ integrity with en face thickness mapping. Alterations in EZ occur in a significant proportion of eyes after ocriplasmin therapy. The EZ-RPE volume and the EZ-RPE central foveal area typically recover to baseline by 3 months. This effect appears to be panretinal and associated with subjective symptoms.
authors.affiliation: Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Itoh
authors.forename: Justis P
authors.initials: JP
authors.lastname: Ehlers
mesh_terms: D000368:Aged; D005260:Female; D005341:Fibrinolysin / Q000008:administration & dosage*; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000008:administration & dosage*; D012167:Retinal Perforations / Q000188:drug therapy*; D055213:Retinal Pigment Epithelium; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000188:drug therapy; D041623:Tomography, Optical Coherence
chemical_list: D005343:Fibrinolytic Agents; D010446:Peptide Fragments; C054561:microplasmin; D005341:Fibrinolysin