Profile of ocriplasmin and its potential in the treatment of vitreomacular adhesion

Abstract

The recent approval by the US Food and Drug Administration of ocriplasmin for the treatment of symptomatic vitreomacular adhesion (VMA), often associated with vitreomacular traction (VMT) and macular hole (MH), has brought new attention to the field of pharmacologic vitreolysis. The need for an enzyme to split the vitreomacular interface, which is formed by a strong adhesive interaction between the posterior vitreous cortex and the internal limiting membrane, historically stems from pediatric eye surgery. This review summarizes the different anatomic classifications of posterior vitreous detachment or anomalous posterior vitreous detachment and puts these in the context of clinical pathologies commonly observed in clinical practice of the vitreoretinal specialist, such as MH, VMT, age-related macular degeneration, and diabetic macular edema. We revisit the outcome of the Phase II studies that indicated ocriplasmin was a safe and effective treatment for selected cases of symptomatic VMA and MH. Release of VMA at day 28 was achieved by 26.5% of patients in the ocriplasmin group versus 10.1% in the placebo group (P<0.001). Interestingly, for MHs, the numbers were more remarkable. Predictive factors for successful ocriplasmin treatment were identified for VMT (VMA diameter smaller than 1,500 μm) and MH (smaller than 250 μm). In comparison with the highly predictable outcome after vitrectomy, the general success rate of ocriplasmin not under clinical trial conditions has not fully met expectations and needs to be proven in real-world clinical settings. The ocriplasmin data will be compared in the future with observational data on spontaneous VMA release, will help retina specialists make more accurate predictions, and will improve outcome rates.

Pneumatic Vitreolysis for Relief of Vitreomacular Traction

“… 21 , 24 In this series, all eyes with successful MH closure had a baseline MH diameter of within 250 μ m. Three of the 5 Stage 2 MH that failed to close had a baseline diameter of >250 μ m. The successful closure of small MH with PVL is consistent with previous reports. 21 , 24 , 25 Previous published studies on ocriplasmin 14 , 15 , 36 also showed an increased success rate for resolving MH of <200 μ m in diameter.…”

“…Ocriplasmin (Jetrea; ThromboGenics NV, Leuven, Belgium) seemed to fulfill such a niche when pilot studies and the Trial of Microplasmin Intravitreal Injection for Non-surgical Treatment of Focal Vitreomacular Adhesion (MiVI-TRUST) Trials (TG-MV-006 and TG-MV-007) showed its promotion of a posterior vitreous detachment (PVD). 14 , 15 Ocriplasmin was approved by the Food and Drug Administration for treatment of symptomatic VMT in 2012. The intravitreal administration of this recombinant protein composed of the catalytic domain of human plasmin provides a potential advantage over a vitrectomy for treating VMT because its injection is performed in the office setting.…”

Ocriplasmin in the Treatment of Vitreomacular Traction in a Patient with Central Retinal Vein Occlusion: A Case Report

“…Considering its ability to induce PVD, other ophthalmic conditions and pathologies related to VMA might benefit from ocriplasmin intravitreal injection, i.e. DME, ARMD, vitreoretinal surgery, uveitic macular edema, pediatric eyes before vitrectomy; nevertheless, first results were not as satisfying as the ones achieved in the treatment of VMA [ 14 , 15 ]. Further research is needed to better understand the clinical indications, visual improvement and, most of all, potential interactions with other medications.…”

Special considerations for pediatric vitreoretinal surgery

“…It is a stable, truncated form of plasmin and has several advantages over plasmin including its stability and smaller size, hence increased ability to penetrate tissues. [18] Its use as an intravitreous injection (125 μg) has been studied in two phase III randomized controlled trials for symptomatic vitreomacular adhesion (VMA) and vitreomacular traction (VMT)[19] and approved for use in more than 50 countries. The MIVI-TRUST study reported VMT release in 26.5% and closure of small full-thickness macular holes in 40.6%.…”