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Incomplete vitreomacular traction release using intravitreal ocriplasmin.

Chin EK, Almeida DR, Sohn EH, Boldt HC, Mahajan VB, Gehrs KM, Russell SR, Folk JC - Case Rep Ophthalmol (2014)

Bottom Line: The mean follow-up period for those who did not undergo vitrectomy was 9 months (range: 1-13).There was an associated reduction in VA after ocriplasmin treatment at 1 month of follow-up.Careful analysis of the vitreoretinal interface and comorbid eye conditions is required to optimize outcome success with ocriplasmin.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

ABSTRACT

Purpose: To report the clinical course of our first 7 consecutive patients treated with intravitreal ocriplasmin (Jetrea(®)).

Methods: Retrospective case series of the first 7 patients treated with ocriplasmin between January and December 2013 at an academic tertiary care center.

Results: The average age was 78.4 years (range: 63-92). Five patients were pseudophakic and 2 patients were phakic in the injected eye. The median baseline visual acuity (VA) was 20/60 (range: 20/25 to 20/200). The median 1-month postinjection VA was 20/70, with a mean loss of 2 lines of VA among all patients. None of the patients had complete resolution of their vitreomacular traction or macular hole at 1 month of follow-up. Three patients had subsequent pars plana vitrectomy and membrane peeling surgery. The mean follow-up period for those who did not undergo vitrectomy was 9 months (range: 1-13). One patient with known ocular hypertension had an increase in intraocular pressure requiring topical pressure-lowering eyedrops. There were no cases of postinjection uveitis, endophthalmitis, retinal tears, or retinal detachment.

Conclusions: While ocriplasmin may be a viable pharmacological agent for vitreolysis, we present a series of patients that all had incomplete resolution of vitreomacular traction with and without full-thickness macular hole. There was an associated reduction in VA after ocriplasmin treatment at 1 month of follow-up. Careful analysis of the vitreoretinal interface and comorbid eye conditions is required to optimize outcome success with ocriplasmin.

No MeSH data available.


Related in: MedlinePlus

a, b Patient No. 1. a FTMH with a focal VMT, mild retinal schisis and intraretinal cysts. b One month after ocriplasmin: persistent FTMH and VMT. The schisis and intraretinal cystoid changes appear less pronounced. c, d Patient No. 2. c A very broad VMA with ill-defined intraretinal hyperreflective spots at the fovea center. d One month after ocriplasmin: persistent broad VMA, intraretinal hyperreflective spots, and new small amount of subretinal fluid at the fovea center. e, f Patient No. 5. e FTMH with focal VMT and small intraretinal cysts. f One month after ocriplasmin: slightly larger FTMH, persistent focal VMT and larger intraretinal cysts. g, h Patient No. 6. g Focal VMA with several small drusen. h One month after ocriplasmin: persistent focal VMA and drusen with new intraretinal cystoid changes. i, j Patient No. 7. i Focal VMT with inner intraretinal cystoid changes. j Persistent thin thread of vitreous remains attached to the foveal retinal interface and with smaller intraretinal cystoid changes.
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Figure 1: a, b Patient No. 1. a FTMH with a focal VMT, mild retinal schisis and intraretinal cysts. b One month after ocriplasmin: persistent FTMH and VMT. The schisis and intraretinal cystoid changes appear less pronounced. c, d Patient No. 2. c A very broad VMA with ill-defined intraretinal hyperreflective spots at the fovea center. d One month after ocriplasmin: persistent broad VMA, intraretinal hyperreflective spots, and new small amount of subretinal fluid at the fovea center. e, f Patient No. 5. e FTMH with focal VMT and small intraretinal cysts. f One month after ocriplasmin: slightly larger FTMH, persistent focal VMT and larger intraretinal cysts. g, h Patient No. 6. g Focal VMA with several small drusen. h One month after ocriplasmin: persistent focal VMA and drusen with new intraretinal cystoid changes. i, j Patient No. 7. i Focal VMT with inner intraretinal cystoid changes. j Persistent thin thread of vitreous remains attached to the foveal retinal interface and with smaller intraretinal cystoid changes.

Mentions: (2) Broad versus Focal Vitreomacular Attachments. We observed 2 patients with broad vitreoretinal adhesions (patient No. 2, fig. 1c, d; patient No. 3, fig. 2b, d) which did not change significantly following intravitreal ocriplasmin. Both these patients went on to develop new trace subretinal fluid and slight worsening of their vision. Interestingly, even those with focal adhesions tended to do poorly in this series. In some cases, the adhesion may have been so strong that the vitreolysis caused increased intraretinal or subretinal fluid, as well as transient subjective and objective blurring in the interim prior to their 1-month follow-up. In a majority of cases, the trace subretinal fluid and/or intraretinal cysts at the fovea center at 1 month of follow-up eventually resolved; however, the VMT or VMA persisted.


Incomplete vitreomacular traction release using intravitreal ocriplasmin.

Chin EK, Almeida DR, Sohn EH, Boldt HC, Mahajan VB, Gehrs KM, Russell SR, Folk JC - Case Rep Ophthalmol (2014)

a, b Patient No. 1. a FTMH with a focal VMT, mild retinal schisis and intraretinal cysts. b One month after ocriplasmin: persistent FTMH and VMT. The schisis and intraretinal cystoid changes appear less pronounced. c, d Patient No. 2. c A very broad VMA with ill-defined intraretinal hyperreflective spots at the fovea center. d One month after ocriplasmin: persistent broad VMA, intraretinal hyperreflective spots, and new small amount of subretinal fluid at the fovea center. e, f Patient No. 5. e FTMH with focal VMT and small intraretinal cysts. f One month after ocriplasmin: slightly larger FTMH, persistent focal VMT and larger intraretinal cysts. g, h Patient No. 6. g Focal VMA with several small drusen. h One month after ocriplasmin: persistent focal VMA and drusen with new intraretinal cystoid changes. i, j Patient No. 7. i Focal VMT with inner intraretinal cystoid changes. j Persistent thin thread of vitreous remains attached to the foveal retinal interface and with smaller intraretinal cystoid changes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4296250&req=5

Figure 1: a, b Patient No. 1. a FTMH with a focal VMT, mild retinal schisis and intraretinal cysts. b One month after ocriplasmin: persistent FTMH and VMT. The schisis and intraretinal cystoid changes appear less pronounced. c, d Patient No. 2. c A very broad VMA with ill-defined intraretinal hyperreflective spots at the fovea center. d One month after ocriplasmin: persistent broad VMA, intraretinal hyperreflective spots, and new small amount of subretinal fluid at the fovea center. e, f Patient No. 5. e FTMH with focal VMT and small intraretinal cysts. f One month after ocriplasmin: slightly larger FTMH, persistent focal VMT and larger intraretinal cysts. g, h Patient No. 6. g Focal VMA with several small drusen. h One month after ocriplasmin: persistent focal VMA and drusen with new intraretinal cystoid changes. i, j Patient No. 7. i Focal VMT with inner intraretinal cystoid changes. j Persistent thin thread of vitreous remains attached to the foveal retinal interface and with smaller intraretinal cystoid changes.
Mentions: (2) Broad versus Focal Vitreomacular Attachments. We observed 2 patients with broad vitreoretinal adhesions (patient No. 2, fig. 1c, d; patient No. 3, fig. 2b, d) which did not change significantly following intravitreal ocriplasmin. Both these patients went on to develop new trace subretinal fluid and slight worsening of their vision. Interestingly, even those with focal adhesions tended to do poorly in this series. In some cases, the adhesion may have been so strong that the vitreolysis caused increased intraretinal or subretinal fluid, as well as transient subjective and objective blurring in the interim prior to their 1-month follow-up. In a majority of cases, the trace subretinal fluid and/or intraretinal cysts at the fovea center at 1 month of follow-up eventually resolved; however, the VMT or VMA persisted.

Bottom Line: The mean follow-up period for those who did not undergo vitrectomy was 9 months (range: 1-13).There was an associated reduction in VA after ocriplasmin treatment at 1 month of follow-up.Careful analysis of the vitreoretinal interface and comorbid eye conditions is required to optimize outcome success with ocriplasmin.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

ABSTRACT

Purpose: To report the clinical course of our first 7 consecutive patients treated with intravitreal ocriplasmin (Jetrea(®)).

Methods: Retrospective case series of the first 7 patients treated with ocriplasmin between January and December 2013 at an academic tertiary care center.

Results: The average age was 78.4 years (range: 63-92). Five patients were pseudophakic and 2 patients were phakic in the injected eye. The median baseline visual acuity (VA) was 20/60 (range: 20/25 to 20/200). The median 1-month postinjection VA was 20/70, with a mean loss of 2 lines of VA among all patients. None of the patients had complete resolution of their vitreomacular traction or macular hole at 1 month of follow-up. Three patients had subsequent pars plana vitrectomy and membrane peeling surgery. The mean follow-up period for those who did not undergo vitrectomy was 9 months (range: 1-13). One patient with known ocular hypertension had an increase in intraocular pressure requiring topical pressure-lowering eyedrops. There were no cases of postinjection uveitis, endophthalmitis, retinal tears, or retinal detachment.

Conclusions: While ocriplasmin may be a viable pharmacological agent for vitreolysis, we present a series of patients that all had incomplete resolution of vitreomacular traction with and without full-thickness macular hole. There was an associated reduction in VA after ocriplasmin treatment at 1 month of follow-up. Careful analysis of the vitreoretinal interface and comorbid eye conditions is required to optimize outcome success with ocriplasmin.

No MeSH data available.


Related in: MedlinePlus