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INTRAVITREAL OCRIPLASMIN IN CLINICAL PRACTICE: Predictors of Success, Visual Outcomes, and Complications

Feng, Henry, L., MD*; Roth, Daniel, B., MD*; Hasan, Aisha, BA*; Fine, Howard, F., MD, MHSc*; Wheatley, H., Matthew, MD*; Prenner, Jonathan, L., MD*; Shah, Sumit, P., MD*; Modi, Kunjal, K., MD*; Feuer, William, J., MS

doi: 10.1097/IAE.0000000000001505
Original Study

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 μm (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.

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.

*Department of Ophthalmology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; and

Bascom Palmer Eye Institute, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.

Reprint requests: Daniel B. Roth, MD, Rutgers Robert Wood Johnson Medical School, 10 Plum Street, Suite 600, New Brunswick, NJ 08901; e-mail: rothretina@gmail.com

ThromboGenics funded the data collection for this study with an unrestricted research grant.

Presented in part at “Long-term Visual Outcomes after Intravitreal Ocriplasmin for the Treatment of Symptomatic Vitreomacular Adhesion,” American Society of Retina Specialists meeting, San Diego, CA, August 11, 2014; and also at “Ocriplasmin for the Treatment of Vitreomacular Traction: Predictors of Success and Complications,” Macula Society Meeting, Key Largo, FL, February 21, 2014, by D. B. Roth, H. L. Feng, K. K. Modi, H. F. Fine, H. M. Wheatley, and W. Feuer.

None of the authors has any conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.