Predicting macular hole closure with ocriplasmin based on spectral domain optical coherence tomography

Abstract

Purpose To assess the preoperative features of patients with idiopathic macular hole (IMH) and vitreomacular adhesion (VMA) treated with ocriplasmin (OCP) that can predict successful closure. Method Data were prospectively collected on all patients with IMH treated with OCP in three British ophthalmic centres. Several preoperative variables were recorded including the IMH base diameter (BD), minimum linear diameter (MLD), and VMA width measured on spectral domain optical coherence tomography. Several other IMH indices were derived including a 'width factor', defined as the BD minus the MLD in μm. The occurrence of VMA release and hole closure were used as the main outcome measures. Results Thirty-three patients in total with IMH were treated with OCP. Two patients developed rhegmatogenous retinal detachment and were excluded. The mean age of the remaining 31 patients was 71 years, and 71% were female. VMA release occurred in 19 of the 31 (61%) patients and macular hole closure in 11 (35%). Width factor was the most predictive feature for closure on multivariate analysis. The deviance R 2 was 67% (Po0.001). An IMH with a width factor of o60 μm had a 95% certainty of closure, whereas if 4290 μm then there was less than a 5% chance of closure. Neither VMA width nor MLD alone was associated with VMA release or closure. Conclusions Patients with macular holes where the BD was close in size to the MLD had an improved probability of closure than holes with wider base configurations.

Epidemiology and morphology of full‐thickness macular holes

“…Steel et al. () reported that FTMH in a presumably earlier stage with narrow MLD relative to BD, had a greater chance to close following intravitreal ocriplasmin injection. These observations allow us to propose a model of FTMH maturation from a cylinder shape into an hourglass shape, which is accelerated by the release of the VMT.…”

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

“…In contrast, treatment of early FTMH with intravitreal gas injection seems discouraging in our study. Steel et al [22] recently showed that MHs with a narrower base configuration relative to the minimum linear diameter had a higher closure rate when treated with ocriplasmin. Due to the small number of cases, we could not verify the relationship between the MH configuration and success rate in the current study.…”

Ocriplasmin for Treatment of Vitreomacular Traction: An Update

“…To better identify OCT features that may predict hole closure other than hole size, Steel et al prospectively evaluated outcomes in 31 eyes with idiopathic small or medium FTMH treated with ocriplasmin [18]. Mean hole size was 278 μm (range 80–395 μm).…”