OCRIPLASMIN FOR VITREO MACULAR TRACTION (VMT ) AND STAGE 2 MACULAR HOLES (MH)
V Kotamarthi, Mr T El-Khashab
Leighton Hospital Mid Cheshire NHS Foundation Trust
United Kingdom
Background: Ocriplasmin (trade name Jetrea) is a recombinant protease with activity against
fibronectin and laminin, components of the vitreoretinal interface. It is used through intra-vitreal
route for treatment of symptomatic vitreo-macular traction without epimacular membrane and
in stage 2 macular holes of less than 400 microns in size (NICE guidance, UK)
Ocriplasmin is a truncated form of the human serine protease plasmin with enzymatic
properties.
Purpose :
To evaluate the efficacy of intra-vitreal Ocriplasmin in causing therapeutic vitreolysis
METHOD
• Prospective review of 24 patients either with symptomatic VMT without epimacular membrane(14) or a stage two macular hole of less than 400
microns (10)
• Slit lamp examination of the fundus and OCT were used to compare before and after the injection
• Follow up period 6 to 12 months after the intra-vitreal injection
DEMOGRAPHY
•
•
•
•
Mean age: 73.50 years
24 patients
Female:Male 16: 8
(2:1)
RESULTS
• 12 out of 24 cases (50%) had successful end point of release of traction with complete successful PVD
• In case of stage 2 MH, the success rate of closure was 7 out of 10 ( 70%), average size 189 microns. In 7
successful cases , 5 had complete posterior vitreous detachment (PVD) and two had only a partial (PVD) but
still the hole closed with negative Watzke Allen’s test
• Out of the 3 unsuccessful cases of stage 2 MH (average hole size 305 microns) two cases had complete PVD
but still the macular hole did not close and the hole size increased after PVD
• In symptomatic (VMT) cases , 5 out of 1 4 ( 36%) were successful
• No complications were noted.
Successful
closure
without
complete
PVD
Persisting
anteroposterior
traction
CONCLUSION 1. Smaller MH (less then 250-300 microns) had a better outcome
2. VMT resolved in 36% of patients whose adhesions were ≤ 1,500 μm. Success also depended on the thickness
(hyperreflectivity) of the posterior hyaloid
3. Tangential traction, apart from anteroposterior vitreous traction does play a role in the pathogenesis of the
macular hole as two cases had successful closure without complete PVD (persisting antero-posterior traction )
and two macular holes of 267 and 372 microns did not close despite a PVD on the OCT showing release of
antero-posterior traction after intraocular Ocriplasmin.
Financial disclosure : None