First Author: S.Groselli GERMANY
Co Author(s): K. Wehrmann N. Feucht C. Lohmann M. Maier
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Ocriplasmin (Jetrea®) is a therapeutic option for patients with focal vitreomacular traction (VMT) with or without small full thickness macular holes (FTMH). Retinal alterations after injection with Ocriplasmin have been described. The purpose of this essay was to determine Ocriplasmin-associated side-effects and changes in the retinal microstructure. Therefore we observed patients after treatment with Ocriplasmin over the course of 1-year post Jetrea intravitreal injection (IVT).
Department of Ophthalmology, Klinikum Rechts der Isar, Technical University of Munich
We included 68 patients with Ocriplasmin treatment in our study. On all patients SD-OCT (optical coherence tomography) scans were performed prior to injection with Ocriplasmin. Follow-up scans were acquired in intervals of 1 week, 1 month, 3 months, 6 months and 1 year after IVT with Ocriplasmin. If present, adverse events were registered. The OCT scans were then evaluated taking the following into account: macular hole size, macular edema, subretinal fluid (SRF), changes in the ellipsoid zone (EZ) and the external limiting membrane (ELM).
20 of the 68 examined patients showed a preoperative FTMH. One week after Ocriplasmin IVT 8 of the 20 FTMHs were already closed. Overall 12 patients showed a FTMH closure after the Ocriplasmin IVT. 4 patients developed a FTMH after Ocriplasmin IVT. 12 of the 24 MF patients still required an operative closure of the FTMH. We noticed a resolution of the VMT on 51 patients. 2 patients developed a retinal detachment after Ocriplasmin IVT successfully repaired with surgery. Furthermore, after Ocriplasmin IVT we detected changes in the EZ and ELM on 9 patients, 18 patients noticed photopsies, 2 patients noticed dyschromatopsia and 2 patients developed visual impairment at night.
Ocriplasmin is a substantial minimal invasive option in the therapy of VMT with or without small FTMH. Nevertheless, there seem to be some specific Ocriplasmin-associated risks, although usually transient. Alterations of the ellipsoid zone (of the outer retina) and persisting SRF seem common and can take months to vanish. Severe complications like retinal detachment are rare but exist. Therefore, every indication of Ocriplasmin should be considered carefully. Especially in VMT eyes with relatively good visual acuity (VA) and limited possible VA gains, the potential risks should be weighed up.