Early Evolution of the Vitreomacular Interface and Clinical Efficacy After Ocriplasmin Injection for Symptomatic Vitreomacular Adhesion

Meyer, Jacob C.; Shah, Gaurav K.; Blinder, Kevin J.; Waheed, Nadia K.; Reichel, Elias; Stalmans, Peter; Singer, Michael; Tewari, Asheesh

doi:10.3928/23258160-20150213-21

Cited by 12 publications

(13 citation statements)

References 12 publications

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“…We found higher VMT release rates than the MIVI-TRUST trials (56.6 vs. 26.5%) that are in line with previous series investigated by several authors with release rates ranging from 30 to 71% [7,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29] and may arise from a favorable patient sample: few patients with ERM (11.0%), only 3.6% of patients with adhesion diameter >1,500 µm and 72.3% of patients with phakic eyes. In fact, 12 eyes in our sample fitted the ideal characteristics described by Haller et al [13] (age <65 years, absence of ERM, phakic, adhesion diameter ≤1,500 µm and FTMH ≤250) and had a release rate of 91.7% (n = 11).…”

Section: Discussionsupporting

confidence: 92%

“…Interestingly, following the MIVI-TRUST trials, several authors described some small series (10-58 eyes) from the real clinical setting with higher resolution rates after ocriplasmin injection, ranging from 30 to 71% [7,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29]. Still, real-life experience data is limited and usually from single-center retrospective studies.…”

Section: Introductionmentioning

confidence: 99%

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The Portuguese Experience with Ocriplasmin in Clinical Practice

Figueira

Martins²,

Pessoa³

et al. 2016

Ophthalmic Res

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

The Portuguese Experience with Ocriplasmin in Clinical Practice

Figueira

Martins²,

Pessoa³

et al. 2016

Ophthalmic Res

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“…Chatziralli et al [15] found that the vitreofoveal angle increased initially in the first week after ocriplasmin injection before release of the VMT. Narrowing of the area of vitreomacular adhesion [23,24] and gradual contraction and loosening of the hyaloid in SD-OCT [16] have also been noticed after ocriplasmin injection. These were different from the effect of intravitreal gas in which both flattening and steepening of the foveal configuration could be observed.…”

Section: Discussionmentioning

confidence: 88%

Vitreomacular Changes after Intravitreal Gas Injection for Idiopathic Impending or Early Macular Hole: An Optical Coherence Tomography Study

et al. 2017

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Purpose: To study the early changes of vitreomacular microstructure by optical coherence tomography (OCT) after intravitreal gas injection for the treatment of idiopathic impending or early full-thickness macular hole (FTMH). Methods: A retrospective, interventional case series. Results: A total of 21 eyes were included. In the impending macular hole, 8/8 achieved vitreomacular traction (VMT) release, while a macular hole developed in 1 case. On postoperative day 1, the vitreomacular configuration by OCT showed either a flattening (n = 3) or elevation (n = 1) pattern. In early FTMH, vitreomacular separation was achieved in 10/13 cases, but macular hole closure was only observed in 3 cases. On postoperative day 1, only flattening of the vitreomacular configuration was observed (n = 5). Enlargement of the macular hole was found in 4 cases. Conclusions: VMT separation can be achieved with intravitreal gas injection by mechanically stretching the posterior vitreous cortex, causing either flattening or steepening of the vitreomacular configuration. However, it did not always result in macular hole closure.

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“…40,41 Among the 26 studies, 22 reported FTMH closure rates (see Table 1). Of these, 13 reported study group averages before and after ocriplasmin treatment, with the vast majority (12) reporting mean VA improvement 26,44,45,48,50,[53][54][55][56][57]59,62 and one reporting VA decline (see Figure 3). 63 Study follow-up times ranged from 19 days to 8.7 months.…”

Section: Ocriplasmin Overview and Review Of Recent Publicationsmentioning

confidence: 99%

Ocriplasmin Efficacy – An Analysis of Real-World Results From 2013 to 2015

Kuppermann¹

2015

European Ophthalmic Review

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As the eye ages, physiological events predispose it to posterior vitreous detachment. This normal ageing process can be complicated by persistent vitreomacular adhesion, which may develop into vitreomacular traction (VMT) accompanied by visual symptoms if forces are great enough to cause macular anatomical changes. Ocriplasmin represents a pharmacological treatment option for VMT resolution.The results of studies and cases reporting ocriplasmin treatment subsequent to US Food and Drug Administration (FDA) approval are presented. Analysis of 26 studies showed that 23 (88 %) reported VMT resolution efficacy results above 40 %, well higher than the 26.5 % efficacy reported in the two pivotal clinical trials. Subsequent analysis revealed patient baseline characteristics predicted to have higher VMT resolution. These clinical trial results were confirmed in 14 post-approval studies with subgroup analysis, consistently showing that patients with specific criteria had higher resolution than their non-criteria-matching counterparts. Visual acuity (VA) group averages were reported by 13 of 18 studies, with 12 (92 %) reporting VA improvement. Case reports of patients receiving ocriplasmin showed 10 of 15 (67 %) with VA improvement; the five cases reporting visual decline reported relatively short follow-up periods. A full understanding of ocriplasmin efficacy in clinical settings will help further identify ideal candidates for ocriplasmin treatment. An important advance in the understanding and treatment of VMT and FTMH was the development of optical coherence tomography (OCT) technology. OCT provides the basis for greater visualisation of vitreomacular anatomy and has allowed for standardisation in the definitions of VMA, This in turn has provided a more accurate understanding of both retinal anatomy and the pathophysiological processes of VMT and FTMH. 2 The importance of this technology is underscored by the fact that focal VMA can be first discovered on routine examination using OCT. 5,6,8,16 This provides an opportunity to appropriately manage these cases and follow them properly, and to make a decision on when and how to intervene. Use of OCT and standardisation of definitions and treatment algorithms will aid in the development and timing of appropriate treatments.

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Early Evolution of the Vitreomacular Interface and Clinical Efficacy After Ocriplasmin Injection for Symptomatic Vitreomacular Adhesion

Abstract: Ocriplasmin was effective for VMA resolution, with a rapid onset of action. Patients with worse baseline VA showed a higher VMA resolution rate.

Cited by 12 publications

References 12 publications

The Portuguese Experience with Ocriplasmin in Clinical Practice

The Portuguese Experience with Ocriplasmin in Clinical Practice

Vitreomacular Changes after Intravitreal Gas Injection for Idiopathic Impending or Early Macular Hole: An Optical Coherence Tomography Study

Ocriplasmin Efficacy – An Analysis of Real-World Results From 2013 to 2015

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