First Author: A.Abreu PORTUGAL
Co Author(s): B. Pessoa J. Coelho N. Correia J. Melo Beirao A. Meireles
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To evaluate the efficacy and safety profile of intravitreal ocriplasmin (125μg) using a guided injection method for the treatment of diabetic macular edema (DME) with vitreomacular adhesion (VMA).
Department of Ophthalmology of a tertiary referral centre in Oporto, Portugal - Centro Hospitalar Universitário do Porto
Interventional study in which patients with DME with VMA underwent guided intravitreal injection of ocriplasmin (125 μg) proximal to VMA, using a surgical microscope and a 25-gauge 1-inch. DME was treated, when necessary, with laser and intravitreal injections of anti-angiogenic drugs. A minimum follow-up of three months after ocriplasmin injection was considered. The primary endpoint was resolution of VMA during follow-up. Secondary endpoints included the variation of maximum central macular thickness (MCMT), best corrected visual acuity (BCVA) and number of intravitreal injections of anti-angiogenic drugs during follow-up.
Eight eyes of seven patients, with a mean age of 67.4±4.8 years, were included. 62.5% were pseudophakic. At the time of ocriplasmin injection the mean VMA size was 438.5±194.4 μm. VMA release rate of 75% was observed, occurring on average at day 35. Median BCVA pre-ocriplasmin injection was 61.5 (range from 40 to 80) EDTRS letters, increasing to 69.0 (range from 55 to 85) EDTRS letters during follow-up (p<0.05). During follow-up, median MCMT improved from 388 μm (range from 315 to 479 μm) to 343 μm (range from 301 to 447 μm) (p<0.05). A decrease in the number of intravitreal injections of anti-angiogenic drugs (p<0.05) was observed in eyes with VMA release. Side effects were minimal and transient.
Preliminary results of this method of guided ocriplasmin injection are favorable, obtaining a VMA resolution rate superior higher than the conventional method. This therapeutic approach to DME associated with VMA appears to be safe and effective, with significant improvement in visual acuity and macular edema.