Skip to main content

Advertisement

Log in

Real-life experience after intravitreal ocriplasmin for vitreomacular traction and macular hole: a spectral-domain optical coherence tomography prospective study

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate prospectively the anatomical and functional results after ocriplasmin injection in patients with vitreomacular traction (VMT), or macular hole (MH) combined with VMT, providing the real-life experience of three centers, using spectral domain-optical coherence tomography (SD-OCT).

Methods

Twenty-four patients with VMT (17 with VMT alone and 7 with an MH combined with VMT) were treated with a single ocriplasmin injection and followed-up prospectively at baseline, day 1, 7, 28 and the last examination of the follow-up for each patient (range: 30–127 days). Best-corrected visual acuity (BCVA) and SD-OCT were performed for patient assessment, while various adverse events were recorded and analysed. At baseline, univariate analysis was also performed to examine the potential predictive factors for VMT release.

Results

66.7 % of patients presented VMT release at the end of the follow-up, while 28.6 % exhibited MH closure. Baseline positive predictive factors for VMT release were young age, being female, phakic lens status, increased vitreofoveal angle, V-shaped and loose vitreomacular adhesion, small adhesion area, thin vitreous strands at the adhesion site and absence of an epiretinal membrane. Four new cases of ellipsoid line changes and subretinal fluid development became evident at day 7 compared to baseline. Lamellar macular hole (LMH) in four cases was first noticed at day 28 post injection. Formation of cystoid macular edema (CME) was noticed in three new cases at day 28 compared to baseline.

Conclusions

Our study demonstrated a VMT release rate of 66.7 %. Apart from the known baseline factors that influence VMT release after ocriplasmin injection, the size of the vitreofoveal angle, a V-shaped and loose vitreomacular adhesion, a small adhesion area, and thin vitreous strands at the adhesion site, could additionally affect the outcome of VMT release. In addition, we studied when VMT release and concomitant events occur and for how long the induced complications lasted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Sebag J (2009) Vitreous: the resplendent enigma. Br J Ophthalmol 93:989–991

    Article  PubMed  CAS  Google Scholar 

  2. Uchino E, Uemura A, Ohba N (2001) Initial stages of posterior vitreous detachment in healthy eyes of older persons evaluated by optical coherence tomography. Arch Ophthalmol 119:1475–1479

    Article  PubMed  CAS  Google Scholar 

  3. Johnson MW (2005) Perifoveal vitreous detachment and its macular complications. Trans Am Ophthalmol Soc 103:537–567

    PubMed  PubMed Central  Google Scholar 

  4. Girach A, Pakola S (2012) Vitreomacular interface diseases. Pathophysiology, diagnosis and future treatment options. Expert Rev Ophthalmol 7:311–323

    Article  CAS  Google Scholar 

  5. Jackson TL, Nicod E, Simpson A, Angelis A, Grimaccia F, Kanavos P (2013) Symptomatic vitreomacular adhesion. Retina 33:1503–1511

    Article  PubMed  CAS  Google Scholar 

  6. Theodossiadis GP, Chatziralli IP, Sergentanis TN, Datseris I, Theodossiadis PG (2014) Evolution of vitreomacular adhesion to acute vitreofoveal separation with special emphasis on a traction-induced foveal pathology. A prospective study of spectral-domain optical coherence tomography. Graefes Arch Clin Exp Ophthalmol (in press). doi:10.1007/s00417-014-2826-9

  7. Duker JS, Kaiser PK, Binder S, de Smet MD, Gaudric A, Reichel E, Sadda SR, Sebag J, Spaide RF, Stalmans P (2013) The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology 120:2611–2619

    Article  PubMed  Google Scholar 

  8. Stalmans P, Duker JS, Kaiser PK, Heier JS, Dugel PU, Gandorfer A, Sebag J, Haller JA (2013) Oct-based interpretation of the vitreomacular interface and indications for pharmacologic vitreolysis. Retina 33:2003–2011

    Article  PubMed  CAS  Google Scholar 

  9. Odrobina D, Michalewska Z, Michalewski J, Dzięgielewski K, Nawrocki J (2011) Long-term evaluation of vitreomacular traction disorder in spectral-domain optical coherence tomography. Retina 31:324–331

    Article  PubMed  Google Scholar 

  10. Theodossiadis GP, Grigoropoulos VG, Theodoropoulou S, Datseris I, Theodossiadis PG (2014) Spontaneous resolution of vitreomacular traction demonstrated by spectral-domain optical coherence tomography. Am J Ophthalmol 157:842–851

    Article  PubMed  Google Scholar 

  11. Ezra E, Gregor ZJ, Moorfields Macular Hole Study Group (2004) Surgery for idiopathic full-thickness macular hole: two-year results of a randomized clinical trial comparing natural history, vitrectomy, and vitrectomy plus autologous serum: Moorfields Macular Hole Study Group report number 1. Arch Ophthalmol 122:224–236

    Article  PubMed  Google Scholar 

  12. Hikichi T, Akiba J, Trempe CL (1993) Effect of the vitreous on the prognosis of full-thickness idiopathic macular hole. Am J Ophthalmol 116:273–278

    Article  PubMed  CAS  Google Scholar 

  13. Mester V, Kuhn F (2000) Internal limiting membrane removal in the management of full-thickness macular holes. Am J Ophthalmol 129:769–777

    Article  PubMed  CAS  Google Scholar 

  14. Kuppermann BD (2012) Ocriplasmin for pharmacologic vitreolysis. Retina 32:225–228

    Article  Google Scholar 

  15. Syed YY, Dhillon S (2013) Ocriplasmin: a review of its use in patients with symptomatic vitreomacular adhesion. Drugs 73:1617–1625

    Article  PubMed  Google Scholar 

  16. Stalmans P, Benz MS, Gandorfer A, Kampik A, Girach A, Pakola S, Haller JA, MIVI-TRUST Study Group (2012) Enzymatic vitreolysis with ocriplasmin for vitreomacular traction and macular holes. N Engl J Med 367:606–615

    Article  PubMed  CAS  Google Scholar 

  17. Haller JA, Stalmans P, Benz MS, Gandorfer A, Pakola SJ, Girach A, Kampik A, Jaffe GJ, Toth CA, MIVI-TRUST Study Group (2015) Efficacy of intravitreal ocriplasmin for treatment of vitreomacular adhesion: subgroup analyses from two randomized trials. Ophthalmology 122:117–122

    Article  PubMed  Google Scholar 

  18. Codenotti M, Iuliano L, Fogliato G, Querques G, Bandello F (2014) A novel spectral-domain optical coherence tomography model to estimate changes in vitreomacular traction syndrome. Graefes Arch Clin Exp Ophthalmol 252:1729–1735

    Article  PubMed  Google Scholar 

  19. Warrow DJ, Lai MM, Patel A, Raevis J, Berinstein DM (2015) Treatment outcomes and spectral-domain optical coherence tomography findings of eyes with symptomatic vitreomacular adhesion treated with intravitreal ocriplasmin. Am J Ophthalmol 159:20–30

    Article  PubMed  Google Scholar 

  20. Lommatzsch AP, Gutfleisch M, Dietzel M, Heimes B, Spital G, Böhme M, Bornfeld N, Pauleikhoff D (2014) Initial clinical experience in the treatment of vitreomacular traction and macular holes with ocriplasmin. Klin Monatsbl Augenheilkd 231:909–914

    Article  PubMed  CAS  Google Scholar 

  21. Kim BT, Schwartz SG, Smiddy WE, Doshi RR, Kovach JL, Berrocal AM, Moshfeghi AA, Fortun JA (2013) Initial outcomes following intravitreal ocriplasmin for treatment of symptomatic vitreomacular adhesion. Ophthalmic Surg Lasers Imaging Retina 44:334–343

    Article  PubMed  Google Scholar 

  22. Singh RP, Li A, Bedi R, Srivastava S, Sears JE, Ehlers JP, Schachat AP, Kaiser PK (2014) Anatomical and visual outcomes following ocriplasmin treatment for symptomatic vitreomacular traction syndrome. Br J Ophthalmol 98:356–360

    Article  PubMed  Google Scholar 

  23. Sharma P, Juhn A, Houston SK, Fineman M, Chiang A, Ho A, Regillo C (2015) Efficacy of intravitreal ocriplasmin on vitreomacular traction and full-thickness macular holes. Am J Ophthalmol (in press). doi:10.1016/j.ajo.2015.01.034

  24. de Smet MD, Jonckx B, Vanhove M, van Calster J, Stalmans P, Stassen JM (2012) Pharmacokinetics of ocriplasmin in vitreous. Invest Ophthalmol Vis Sci 53:8208–8213

    Article  PubMed  Google Scholar 

  25. Stalmans P, Girach A (2013) Vitreous levels of active ocriplasmin following intravitreal injection: results of an ascending exposure trial. Invest Ophthalmol Vis Sci 54:6620–6627

    Article  PubMed  CAS  Google Scholar 

  26. Meyer CH, Rodrigues EB, Mennel S, Schmidt JC, Kroll P (2004) Spontaneous separation of epiretinal membrane in young subjects: personal observations and review of the literature. Graefes Arch Clin Exp Ophthalmol 242:977–985

    Article  PubMed  Google Scholar 

  27. Thanos A, Hernandez-Siman J, Marra KV, Arroyo JG (2014) Reversible vision loss and outer retinal abnormalities after intravitreal ocriplasmin injection. Retin Cases Brief Rep 8:330–332

    Article  PubMed  Google Scholar 

  28. Freund KB, Shah SA, Shah VP (2013) Correlation of transient vision loss with outer retinal disruption following intravitreal ocriplasmin. Eye 27:773–774

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  29. Hager A, Seibel I, Riechardt A, Rehak M, Joussen AM (2014) Does ocriplasmin affect the RPE-photoreceptor adhesion in macular holes? Br J Ophthalmol (in press). doi:10.1136/bjophthalmol-2014-305620

  30. Itoh Y, Kaiser PK, Singh RP, Srivastava SK, Ehlers JP (2014) Assessment of retinal alterations after intravitreal ocriplasmin with spectral-domain optical coherence tomography. Ophthalmology 121:2506–2507

    Article  PubMed  PubMed Central  Google Scholar 

  31. Chod RB, Goodrich C, Saxena S, Akduman L (2015) Lamellar macular hole after intravitreal ocriplasmin injection. BMJ Case Rep (in press). doi:10.1136/bcr-2014-207810

  32. Casswell E, Fernandez-Sanz G, Mitry D, Luk S, Zakir R (2014) Macular hole progression following ocriplasmin intravitreal injection. Case Rep Ophthalmol Med 2014:403461

    PubMed  PubMed Central  Google Scholar 

Download references

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria, educational grants, or other equity interest), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to George Theodossiadis.

Additional information

There is no need for ClinicalTrials.gov registration, as this study is not a trial.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chatziralli, I., Theodossiadis, G., Parikakis, E. et al. Real-life experience after intravitreal ocriplasmin for vitreomacular traction and macular hole: a spectral-domain optical coherence tomography prospective study. Graefes Arch Clin Exp Ophthalmol 254, 223–233 (2016). https://doi.org/10.1007/s00417-015-3031-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-015-3031-1

Keywords

Navigation