title: [Pharmaological vitreolysis with ocriplasmin as a treatment option for symptomatic focal vitreomacular traction with or without macular holes (≤400 μm) compared to tranconjunctival vitrectomy].
abstract: BACKGROUND
  To evaluate the resolution rate in patients with symptomatic vitreomacular traction (VMT) ≤ 1500 μm with or without macular holes ≤ 400 μm after therapy with intravitreal ocriplasmin (Jetrea®) injections in a clinical setting in comparison to transconjunctival vitrectomy.
  
  
  METHODS
  We examined 21 eyes of 21 consecutive patients with vitreomacular traction with or without macular holes who underwent intravitreal injection of 0.1 ml ocriplasmin and we retrospectively reviewed 18 eyes of 18 patients with VMT with or without FTMH who underwent 23-gauge vitrectomy.
  
  
  RESULTS
  Vitreomacular traction resolved in 15 of 21 eyes treated with ocriplasmin after 6 month (71 %) compared to 100 % of eyes treated by vitrectomy. Of the 5 eyes that initially presented FTMH with VMT in the ocriplasmin group, 2 were closed 1 month after ocriplasmin treatment. The remaining 3 had vitrectomy and closed thereafter. Best corrected visual acuity was 0.38 ± 0.23 LogMAR at baseline, improving to 0.34 ± 0.24 LogMAR at 6 months after ocriplasmin treatment. Best corrected visual acuity in the vitrectomy group improved from 0.55 ± 0.29 LogMAR before operation to 0.53 ± 0.51 LogMAR 6 months postoperatively. Foveal thickness was 355.95 ± 114.53 μm at baseline, reducing to 277.77 ± 40.26 μm at 6 months after ocriplasmin treatment. Foveal thickness of eyes that underwent vitrectomy was 494.61 ± 126.02 μm at baseline, decreasing to 330.2 ± 88.85 μm 6 months postoperatively.
  
  
  CONCLUSIONS
  When traction is ≤ 1500 μm, enzymatic vitreolysis with ocriplasmin is a therapeutic option. In the presence of VMT >1500 μm or ERM, surgical treatment with vitrectomy is associated with better outcomes. In small macular holes with VMT and in the absence of ERM, enzymatic vitreolysis with ocriplasmin is an option. In cases of holes >400 μm, or in the absence of evident VMT, or in the presence of ERM, vitrectomy is the first choice.
authors.affiliation: Augenklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland. Mathias.Maier@mri.tum.de.
authors.forename: M
authors.initials: M
authors.lastname: Maier
authors.affiliation: Augenklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Abraham
authors.affiliation: Augenklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Frank
authors.affiliation: Augenklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland.
authors.forename: C P
authors.initials: CP
authors.lastname: Lohmann
authors.affiliation: Augenklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland.
authors.forename: N
authors.initials: N
authors.lastname: Feucht
mesh_terms: D000368:Aged; D005260:Female; D005341:Fibrinolysin / Q000008:administration & dosage*; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000008:administration & dosage*; D012167:Retinal Perforations / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D063189:Symptom Assessment; D016896:Treatment Outcome; D014821:Vitrectomy / Q000379:methods*; D014822:Vitreous Body / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D020255:Vitreous Detachment / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*
chemical_list: D005343:Fibrinolytic Agents; D010446:Peptide Fragments; C054561:microplasmin; D005341:Fibrinolysin
keywords: Macular hole; OCT; Ocriplasmin; Vitrectomy; Vitreomacular traction