INTRAVITREAL OCRIPLASMIN IN CLINICAL PRACTICE: Predictors of Success, Visual Outcomes, and Complications. Issue 1 (January 2018)

• Record Type: Journal Article
• Authors: Feng, Henry L.; Roth, Daniel B.; Hasan, Aisha; Fine, Howard F.; Wheatley, H. Matthew; Prenner, Jonathan L.; Shah, Sumit P.; Modi, Kunjal K.; Feuer, William J.
• Is Part Of: Retina. Volume 38:Issue 1(2018)
• Publication Date: 2018-01
• Subjects: macular hole -- ocriplasmin -- pharmacologic vitreolysis -- symptomatic vitreomacular adhesion -- vitreomacular traction; Retina -- Diseases -- Periodicals; Retinal Diseases; Vitreous Body; 617.735
• DOI: 10.1097/IAE.0000000000001505
• Languages: English
• ISSNs: 0275-004X

Abstract

Abstract : Purpose: To investigate predictors of success, visual outcomes, and complications of intravitreal ocriplasmin for the treatment of symptomatic vitreomacular adhesion in a clinical care setting. Methods: Retrospective chart review of 49 consecutive eyes of 47 patients who received intravitreal ocriplasmin. Spectral domain optical coherence tomography scans were examined for vitreomacular traction (VMT) release, full-thickness macular hole (FTMH) closure, and other changes in retinal anatomy. Results: Pharmacologic VMT release occurred in 41% of eyes; positive predictors included age ⩽75 years ( P = 0.001), phakic status ( P = 0.016), VMT width ⩽750 μ m ( P = 0.001), and absence of retinal comorbidities ( P = 0.035). Pharmacologic FTMH closure occurred in 25% of cases; positive predictors included successful VMT release ( P = 0.042), better preinjection best-corrected visual acuity ( P = 0.036), and smaller FTMH aperture width ( P = 0.033). Eyes that achieved VMT release and did not undergo surgery attained significant improvement in best-corrected visual acuity ( P = 0.015). Complications included subfoveal lucency (33%), ellipsoid zone disruption (33%), and FTMH base enlargement (75%). Only FTMH base enlargement resulted in worse visual outcomes ( P = 0.024). Subgroup analysis of 14 eyes with ideal characteristics (all positive predictors listed above) yielded a 93% VMT release rate. Conclusion: Proper case selection may facilitate successful pharmacologic vitreolysis with ocriplasmin, improve visual outcomes, and minimize potential complications. Abstract : Pharmacologic vitreolysis is a relatively novel approach in the management of symptomatic vitreomacular adhesion. This single-center study investigates the predictors of success, visual outcomes, and complications of intravitreal ocriplasmin for the treatment of symptomatic vitreomacular adhesion in a clinical care setting.