Long-Term Results of Vitrectomy for Macular Holes after Failure of Vitreolysis

Abstract

Purpose: Ocriplasmin injection may close some small-to-medium macular holes associated with vitreoretinal traction. If the treatment fails, does vitrectomy and gas injection yield the same results as primary surgery? Material and Methods: We report a retrospective case series study of 3 eyes of 3 consecutive patients operated on a few months after initial intravitreal injection of ocriplasmin and enlargement of the macular hole. The minimal follow-up period after surgery was 18 months. Results: Surgery was uneventful in all cases. Vitrectomy, internal limiting membrane peeling, and gas injection allowed closing of the 3 macular holes with a progressive improvement in visual acuity over time. Before ocriplasmin injection, visual acuity ranged from 20/60 to 20/32, after failed ocriplasmin injection from 20/80 to 20/40, and at the final follow-up after 18 months from 20/32 to 20/25. Conclusion: Vitrectomy with internal limiting membrane peeling leads to closure of macular holes even in cases of prior failure to close them by ocriplasmin injection.

Prognostic Factors Associated with Ocriplasmin Efficacy for the Treatment of Symptomatic Vitreomacular Adhesion and Full-thickness Macular Hole: Analysis from Four Studies

“…This is consistent with previous cases showing failure of FTMH closure due to base enlargement following ocriplasmin treatment and subsequent VMA resolution. [37,57] SRF did not have a statistically significant predictive value in our analysis; however, the number of patients showing successful VMA resolution and FTMH closure with SRF were strikingly different between the MIVI-TRUST and OASIS vs ORBIT studies (SRF present: 87% [20/23], 100% [8/8], and 0% [0/30], respectively), perhaps owing in part to differences in SRF measurement protocols at study enrollment and therefore limiting interpretation. In Case 1, presence of SRF did not impact VMA resolution or FTMH closure, although visual acuity improved following SRF resolution.…”

Short-Term Results of Ocriplasmin versus Prompt Vitrectomy for Macular Hole. Which Performs Better?

“…Looking at the BCVA values, previous reports [23][24][25] did not find a real risk in delaying the closure of the MH by one month in patients treated with ocriplasmin plus vitrectomy compared to the vitrectomy alone group. Our findings confirm that delaying the vitrectomy in cases that had undergone unsuccessful vitreolytic treatment with ocriplasmin did not affect the clinical success achieved in terms of visual function, and highlighted that these patients might experience better improvement in retinal sensitivity at three months after surgery in comparison to those for which vitrectomy is selected as first-line treatment.…”

“…However, on post-operative SD-OCT examination, ellipsoid zone disruption was more frequent in the vitrectomized eyes [25]. Moreover, in a limited case series, Benarous et al [23] showed that failure of treatment with ocriplasmin does not compromise the subsequent anatomical and functional success of postponed vitrectomy for macular holes.…”

Inverted Internal Limiting Membrane Flap Technique: Is It the Best Option for Macular Holes?

“…VMT was estimated to be present in 34% of FTMHs, and in only 13% of small FTMHs. 51 , 52 There is no relationship between the FTMH size and the presence of VMT. 75 The most relevant consideration in this type of FTMHs when they are small (<250µm) is the possibility of performing a nonsurgical technique, namely a IVI of ocriplasmin.…”

“… 50 Vitrectomy, ILM peeling, and gas tamponade have shown efficacy in small FMTHs that failed to close after IVI of ocriplasmin. 51 To our knowledge, no studies have reported the anatomical and functional results of the inverted ILM flap technique in FTMHs ≤250µm. Instead, most studies used the cut-off of 400µm to differentiate between small to medium and large FTMHs.…”