Abstract
BACKGROUND AND OBJECTIVE:
To review clinical and structural outcomes of ocriplasmin for treatment of stage 2 macular holes.
PATIENTS AND METHODS:
A retrospective review of the first patients with stage 2 macular holes to be treated with ocriplasmin at Massachusetts Eye and Ear Infirmary. All patients were imaged with spectral-domain optical coherence tomography (SD-OCT).
RESULTS:
Eight patients with stage 2 macular holes received a single injection of 125 μg of ocriplasmin. One patient (12.5%) demonstrated macular hole closure. The posterior hyaloid separated from the macula in six eyes (75%). All seven holes that remained open showed enlargement in hole diameters (narrowest, apical, and basal) at 1 week and 1 month. All seven were successfully closed with surgery. Ellipsoid zone disruptions were observed by OCT in four eyes (50%) and persisted throughout follow-up (more than 6 months on average).
CONCLUSION:
In early clinical results, the authors found a lower macular hole closure rate with ocriplasmin than previously reported. Enlargement was observed in all holes that failed to close with ocriplasmin. The authors found ellipsoid zone disruptions that persisted through 6 months of follow-up after ocriplasmin injection. Further work is needed to investigate the cause for these ellipsoid zone changes.
[Ophthalmic Surg Lasers Imaging Retina. 2014;45:293–297.]
- 1.Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol. 1991; 109(5):654–659 .
10.1001/archopht.1991.01080050068031 Crossref Medline, Google Scholar - 2.Gass J. Stereoscopic atlas of macular diseases: diagnosis and treatment. 3rd edSt. Louis, MO: CV Mosby; 1987. Google Scholar
- 3.Rhéaume MA, Vavvas D. Pharmacologic vitreolysis. Semin Ophthalmol. 2010; 25(5–6):295–302.
10.3109/08820538.2010.518865 Crossref Medline, Google Scholar - 4.Verstraeten TC, Chapman C, Hartzer M, Winkler BS, Trese MT, Williams GA. Pharmacologic induction of posterior vitreous detachment in the rabbit. Arch Ophthalmol. 1993; 111(6):849–854.
10.1001/archopht.1993.01090060139038 Crossref Medline, Google Scholar - 5.Takano A, Hirata A, Inomata Y, Intravitreal plasmin injection activates endogenous matrix metalloproteinase-2 in rabbit and human vitreous. Am J Ophthalmol. 2005; 140(4): 654–660.
10.1016/j.ajo.2005.04.017 Crossref Medline, Google Scholar - 6.Uemura A, Nakamura M, Kachi S, Effect of plasmin on laminin and fibronectin during plasmin-assisted vitrectomy. Arch Ophthalmol. 2005; 123(2):209–213.
10.1001/archopht.123.2.209 Crossref Medline, Google Scholar - 7.Gandorfer A. Microplasmin-assisted vitrectomy. Dev Ophthalmol. 2009; 44:26–30.
10.1159/000223942 Crossref Medline, Google Scholar - 8.Gandorfer A, Rohleder M, Sethi C, Posterior vitreous detachment induced by microplasmin. Invest Ophthalmol Vis Sci. 2004; 45(2): 641–647.
10.1167/iovs.03-0930 Crossref Medline, Google Scholar - 9.de Smet MD, Gandorfer A, Stalmans P, Microplasmin intravitreal administration in patients with vitreomacular traction scheduled for vitrectomy. Ophthalmology. 2009; 116(7):1349–1355.
10.1016/j.ophtha.2009.03.051 Crossref Medline, Google Scholar - 10.Stalmans P, Delaey C, de Smet MD, van Dijkman E, Pakola S. Intravitreal injection of microplasmin for treatment of vitreomacular adhesion: results of a prospective, randomized, sham-controlled phase II trial (the MIVI-IIT trial). Retina. 2010; 30(7):1122–1127.
10.1097/IAE.0b013e3181e0970a Crossref Medline, Google Scholar - 11.Stalmans P, Benz MS, Gandorfer A, Enzymatic vitreolysis with ocriplasmin for vitreomacular traction and macular holes. N Engl J Med. 2012; 367(7):606–615.
10.1056/NEJMoa1110823 Crossref Medline, Google Scholar - 12.Kim B. T., Initial outcomes following intravitreal ocriplasmin for treatment of symptomatic vitreomacular adhesion. Ophthalmic Surg Lasers Imaging Retina. 2013; 44:334–343. Link, Google Scholar
- 13.Singh RP, Li A, Bedi R, Anatomical and visual outcomes following ocriplasmin treatment for symptomatic vitreomacular traction syndrome. Br J Ophthalmol. 2014; 98(3):356–360.
10.1136/bjophthalmol-2013-304219 Crossref Medline, Google Scholar - 14.Freund KB, Shah SA, Shah VP. Correlation of transient vision loss with outer retinal disruption following intravitreal ocriplasmin. Eye (Lond). 2013; 27(6):773–774.
10.1038/eye.2013.94 Crossref Medline, Google Scholar - 15.Duker JS, Kaiser PK, Binder S, The International Vitreomacular Traction Study Group classification of vitreomacular Adhesion, traction, and macular hole. Ophthalmology. 2013; 120(12):2611–2619.
10.1016/j.ophtha.2013.07.042 Crossref Medline, Google Scholar
