The Portuguese Experience with Ocriplasmin in Clinical Practice

Abstract

Aim: Evaluate the real-life experience with ocriplasmin on vitreomacular traction (VMT) release and full-thickness macular hole (FTMH) closure in Portugal. Methods: Multicentric, retrospective study of 83 eyes of 78 patients who were treated with intravitreal ocriplasmin for VMT with and without FTMH. Primary outcomes were VMT release and FTMH closure. Secondary outcomes included visual acuity changes and structural features on spectral-domain ocular coherence tomography. Results: VMT resolved in 47 of the 83 eyes (56.6%) and 6 of the 12 FTMH were closed (50.0%). Mean best-corrected visual acuity (BCVA) improved from 65.1 at baseline to 70.8 ETDRS letters at the end of follow-up (p < 0.0001) with a mean follow-up of 138.8 days. Improvement in BCVA was significantly better in eyes with VMT release (p = 0.021). Approximately 73% of patients had normal ellipsoid zone integrity at the end of follow-up, 87% had no neurosensorial detachment and 40% had no intra- or subretinal fluid. Conclusion: VMT release and FTMH closure were achieved in more than half of the treated eyes and were correlated with significant BCVA improvements and favorable baseline characteristics. In fact, if a careful patient selection is carried out, VMT resolution with ocriplasmin can be optimized, tailoring the best approach to each patient.

Enzymatic vitreolysis for the treatment of tractional diabetic macular edema

“…However, in this study, VMA resolution was achieved in a relatively high percentage of patients (60.9%), compared with other series which reported rates from 26.5% to 64% mainly in nondiabetic patients. 10,22 Positively skewing our results may be the exclusion of patients with ERMs, known to be a negative prognostic factor for the efficacy of ocriplasmin. 23 Nonetheless, our sample has some possible negative prognostic factors, such as the percentage of previous LASER therapy (100%) and broad adhesions (13%).…”

“…The VMA resolution occurred in the majority of the patients until the first month after ocriplasmin, which is in line with outcomes described in other series. 10,22…”

“…Moreover, VMA is regarded as a risk factor for proliferative-type complications such as proliferative vitreoretinopathy and epiretinal gliosis. 10 These macular proliferations may induce additional edema which further impairs vision. 11 Taken together, these tractional mechanic factors may antagonize the effect of anti-VEGF or corticosteroid intravitreal (IV) injections and may be the lead causing factors for pharmacological resistance in patients with macular edema.…”