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Faatz H, Hattenbach LO, Krohne TU, Priglinger SG, Lommatzsch A. [Vitreomacular traction: diagnostics, natural course, treatment decision and guideline recommendations]. DIE OPHTHALMOLOGIE 2024; 121:470-475. [PMID: 38809382 DOI: 10.1007/s00347-024-02042-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/04/2024] [Accepted: 04/15/2024] [Indexed: 05/30/2024]
Abstract
Vitreomacular traction is a tractive foveolar adhesion of the posterior vitreous limiting membrane, resulting in pathological structural alterations of the vitreomacular interface. This must be differentiated from physiological vitreomacular adhesion, which exhibits a completely preserved foveolar depression. Symptoms depend on the severity of the macular changes and typically include reduced visual acuity, reading problems and metamorphopsia. High-resolution spectral domain optical coherence tomography (SDOCT) imaging enables classification of the sometimes only subtle morphological changes. If pronounced vitreomacular traction is accompanied by epiretinal gliosis and alterations to the outer retina, it is referred to as a vitreomacular traction syndrome. Vitreomacular traction has a high probability of spontaneous resolution within 12 months. Therefore, treatment should only be carried out in cases of undue suffering of the patient and with symptoms during bilateral vision and a lack of spontaneous resolution. In addition to pars plana vitrectomy, alternative treatment options, such as intravitreal injection of ocriplasmin and pneumatic vitreolysis are discussed for vitreomacular traction with an associated macular hole; however, ocriplasmin is no longer available in Germany. The best anatomical results in comparative investigations were achieved by vitrectomy. Pneumatic vitreolysis is controversially discussed due to the increased risk of retinal tears. In one of the current S1 guidelines of the German ophthalmological societies evidence-based recommendations for the diagnostics and treatment of vitreomacular traction are summarized.
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Affiliation(s)
- Henrik Faatz
- Augenzentrum am St. Franziskus-Hospital Münster, Hohenzollernring 74, 48145, Münster, Deutschland
- Achim Wessing Institut f. Ophthalmologische Diagnostik, Universitätsklinikum Essen-Duisburg, Essen, Deutschland
| | | | - Tim U Krohne
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Köln, Deutschland
| | - Siegfried G Priglinger
- Department of Ophthalmology University Hospital, Ludwig Maximilians University, München, Deutschland
| | - Albrecht Lommatzsch
- Augenzentrum am St. Franziskus-Hospital Münster, Hohenzollernring 74, 48145, Münster, Deutschland.
- Achim Wessing Institut f. Ophthalmologische Diagnostik, Universitätsklinikum Essen-Duisburg, Essen, Deutschland.
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Li JQ, Hattenbach LO, Lommatzsch A, Priglinger SG, Krohne TU. [Macular hole: Differential diagnosis, treatment options and new guideline recommendations]. DIE OPHTHALMOLOGIE 2024; 121:462-469. [PMID: 38775987 DOI: 10.1007/s00347-024-02047-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 06/19/2024]
Abstract
Full-thickness macular holes (FTMH) usually result in a pronounced reduction of visual acuity and represent one of the most frequent indications for retinal surgery. If diagnosed and treatment is initiated at an early stage, surgery has a high success rate with respect to both hole closure and improvement of visual acuity. Optical coherence tomography (OCT)-based staging and sizing enables an estimation of the surgical outcome. The differential diagnostic distinction from clinically similar disorders, such as lamellar macular holes, macular pseudoholes, and foveoschisis is clinically relevant as the pathogenesis, prognosis and treatment are significantly different. While vitrectomy with peeling of the inner limiting membrane (ILM) and gas tamponade is established as the standard treatment for FTMH, some aspects of treatment are handled differently between surgeons, such as the timing of surgery, the choice of endotamponade and the type and duration of postoperative positioning. For FTMH associated with vitreomacular traction, alternative treatment options in addition to vitrectomy include intravitreal ocriplasmin injection and pneumatic vitreolysis. The current clinical guidelines of the German ophthalmological societies summarize the evidence-based recommendations for diagnosis and treatment of FTMH.
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Affiliation(s)
- Jeany Q Li
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | | | | | | | - Tim U Krohne
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland.
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Neubauer J, Gelisken F, Ozturk T, Bartz-Schmidt KU, Dimopoulos S. The time course of spontaneous closure of idiopathic full-thickness macular holes. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06465-2. [PMID: 38587655 DOI: 10.1007/s00417-024-06465-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/13/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024] Open
Abstract
PURPOSE Spontaneous closure of idiopathic full-thickness macular holes (iFTMH) has been reported regularly. However, little is known about its probability and timeline. METHODS In this retrospective study all consecutive patients who presented between August 2008 and August 2019 were screened for the presence of a macular hole and only iFTMHs were included. The primary outcome measure was the spontaneous closure of the iFTMH. RESULTS Of 1256 eyes with macular holes, 338 fulfilled the inclusion criteria. Spontaneous closure of the iFTMH was detected in 31 eyes (9.2%) with a median time of 44 days after diagnosis. Eyes exhibiting spontaneous closure demonstrated a higher baseline best-corrected visual-acuity (BCVA) and smaller iFTMH diameter (p < 0.0001 and p < 0.0001, respectively). The mean BCVA improved from 0.4 logMAR (SD ± 0.21) to 0.29 logMAR (SD ± 0.20) after spontaneous closure (p = 0.031). The iFTMH diameter was positively correlated with the time to spontaneous closure (Pearson-r = 0.37, p = 0.0377). Spontaneously closed iFTMHs reopened in 16% (n = 5) of cases, with a median of 136 days after closure. A logistic regression model showed the hole diameter was associated with spontaneous closure (odds-Ratio 0.97, 95%CI [0.96, 0.98]). The Kaplan-Meier-Curve revealed that approximately 25% of small-iFTMH (n = 124) and 55% of iFTMH with a diameter < 150µm (n = 48) closed spontaneously within two months. CONCLUSION The established gold-standard for the treatment of iFTMHs is macular surgery. However, the potential for spontaneous closure of small iFTMHs must be acknowledged. Therefore, if surgical treatment is delayed in individual cases, close observation is recommended.
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Affiliation(s)
- Jonas Neubauer
- Department of Ophthalmology, Eberhard Karls University, Elfriede-Aulhorn-Straße 7, 72076, Tuebingen, Germany.
| | - Faik Gelisken
- Department of Ophthalmology, Eberhard Karls University, Elfriede-Aulhorn-Straße 7, 72076, Tuebingen, Germany
| | - Taylan Ozturk
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Karl-Ulrich Bartz-Schmidt
- Department of Ophthalmology, Eberhard Karls University, Elfriede-Aulhorn-Straße 7, 72076, Tuebingen, Germany
| | - Spyridon Dimopoulos
- Department of Ophthalmology, Eberhard Karls University, Elfriede-Aulhorn-Straße 7, 72076, Tuebingen, Germany
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Wood EH, Moshfeghi DM, Capone A, Williams GA, Blumenkranz MS, Sieving PA, Harper CA, Hartnett ME, Drenser KA. A Literary Pediatric Retina Fellowship With Michael T. Trese, MD. Ophthalmic Surg Lasers Imaging Retina 2023; 54:701-712. [PMID: 38113364 DOI: 10.3928/23258160-20231020-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Michael T. Trese, MD (1946-2022), a vitreoretinal surgeon, made significant contributions to the field of retina. Although most known for his work in pediatric retina surgery, he was a pioneer in areas such as medical retina, translational research, and telemedicine. This article reviews his major contributions to spread his knowledge more widely to vitreoretinal trainees and specialists. We discuss six areas where Trese made a lasting impact: lens-sparing vitrectomy, familial exudative vitreoretinopathy, congenital X-linked retinoschisis, autologous plasmin enzyme, regenerative medicine, and telemedicine. [Ophthalmic Surg Lasers Imaging Retina 2023;54:701-712.].
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Boral SK, Agarwal D. Role of Small-Gauge Proportionate Reflux-Assisted Hydrodissection In Elevated Symptomatic Vitreofoveal Traction. Retina 2023; 43:1620-1625. [PMID: 33840788 DOI: 10.1097/iae.0000000000003178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND/PURPOSE To describe a new technique to release the elevated symptomatic vitreofoveal traction. METHODS This was a retrospective, interventional case series where a new technique of hydrodissection by proportionate reflux property of small-gauge vitrectomy cutter was used in cases of elevated symptomatic vitreofoveal traction as evident on optical coherence tomography. After vitrectomy, an opening was made in the taut posterior hyaloid face around the foveal elevation. Then, the cutter tip was insinuated inside the hyaloid opening, and the port opening was directed toward the tip of the fovea at its hyaloid attachment. The proportionate reflux property of the cutter was then used to cause reflux of cassette fluid. The hydrostatic force thus generated separates the vitreofoveal attachment. End point was separation of vitreofoveal traction. RESULTS Seven eyes of seven patients were operated by 27-gauge (n = 3) or 25-gauge (n = 4) vitrectomy system. Mean preoperative and postoperative BCVA were LogMAR 0.44 (20/55) ± 0.14 and LogMAR 0.27 (20/37) ± 0.11, respectively ( P = 0.23). Mean preoperative foveal elevation was 560.86 ± 196.57 μ m, which significantly decreased postoperatively to 251 ± 79.13 μ m ( P < 0.01). VMTs were successfully released in all cases. Mean follow-up was 184.00 ± 80.32 days. CONCLUSION Small-gauge proportionate reflux-assisted hydrodissection is an innovative technique for management of elevated symptomatic cases of vitreofoveal traction.
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Affiliation(s)
- Subhendu K Boral
- Department of Vitreoretina, Disha Eye Hospitals Pvt Ltd, Barrackpore, Kolkata, West Bengal, India
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Quiroz-Reyes MA, Quiroz-Gonzalez EA, Quiroz-Gonzalez MA, Lima-Gomez V. Pneumatic vitreolysis versus vitrectomy for the treatment of vitreomacular traction syndrome and macular holes: complication analysis and systematic review with meta-analysis of functional outcomes. Int J Retina Vitreous 2023; 9:33. [PMID: 37316932 DOI: 10.1186/s40942-023-00472-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/10/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND We conducted a systematic review to compare the effects of pneumatic vitreolysis (PV), enzymatic vitreolysis (EVL) with ocriplasmin, and pars plana vitrectomy (PPV) on vitreomacular traction (VMT) syndrome and macular holes (MHs) to assess their efficacy as treatment options. METHODS Databases, including PubMed, ClinicalTrials.gov ( www. CLINICALTRIALS gov ), the Cochrane Central Register of Controlled Trials (CENTRAL)-including the Cochrane Eyes and Vision Group Trials Register (The Cochrane Library 2013, Issue 2)-, Ovid MEDLINE, and EMBASE (January 2000-October 2022), were searched to identify studies comparing the outcomes of PV versus PPV, PPV versus ocriplasmin and ocriplasmin versus PV. RevMan 5.1 was used for the meta-analysis of the studies. RESULTS Among the 89 studies, 79 were considered eligible for qualitative analysis, and 10 quantitative studies were subjected to meta-analysis. PPV resulted in better postoperative visual acuity improvement than ocriplasmin (standardized mean deviation (SMD) = 0.38, 95% CI 0.03-0.73, p = 0.0003). PV resulted in no significant difference in visual improvement compared with PPV (SMD = - 0.15, 95% CI - 0.47 to 0.16, p = 0.35). PPV was significantly more effective in terms of the VMT release rate (risk ratio = 0.48, 95% CI 0.38-0.62, p = 0.00001) and MH closure rate (risk ratio = 0.49, 95% CI 0.30-0.81, p = 0.006) than ocriplasmin. PV was more effective than ocriplasmin in terms of the VMT release rate (risk ratio = 0.49, 95% CI 0.35-0.70, p = 0.0001). Qualitative analysis showed MH closure rates of 46%, 47.8%, and 95% and VMT releases rates of 46%, 68% and 100% after ocriplasmin, PV, and PPV treatments, respectively. Adverse events and postoperative complications occurring after treatment have also been documented in these studies. CONCLUSION PPV appears to be the most promising option for MH closure and VMT release, with fewer serious complications than EVL or PV. However, given the limited number of studies comparing these treatments, further research is needed to establish the superiority of PPV over the other options.
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Affiliation(s)
- Miguel A Quiroz-Reyes
- Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization), Which is Affiliated with the Postgraduate Studies Division of the National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, Lomas de Chapultepec, 11000, Mexico City, Mexico.
| | - Erick A Quiroz-Gonzalez
- Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization), Which is Affiliated with the Postgraduate Studies Division of the National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, Lomas de Chapultepec, 11000, Mexico City, Mexico
- Institute of Ophthalmology, Fundacion Conde de Valenciana, (Nonprofit Organization), Which is Affiliated with the Postgraduate Studies Division of the National Autonomous University of Mexico, Av. Chimalpopoca 14. Col. Obrera, 06800, Mexico City, Mexico
| | - Miguel A Quiroz-Gonzalez
- Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization), Which is Affiliated with the Postgraduate Studies Division of the National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, Lomas de Chapultepec, 11000, Mexico City, Mexico
| | - Virgilio Lima-Gomez
- Juarez Hospital, Public Assistance Institution (Nonprofit Organization), Av. Politecnico Nacional 5160, Colonia Magdalena de las Salinas, 07760, Mexico City, Mexico
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Liu RZ, Hu YJ, Wang TF, Yu JC, Wang YX, Zhang YL, Yu M, Zhao B. A novel recombinant human microplasminogen induced complete posterior vitreous detachment without morphological change of retina in juvenile rabbits. Exp Eye Res 2023; 230:109465. [PMID: 37030582 DOI: 10.1016/j.exer.2023.109465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023]
Abstract
Vitreomacular traction syndrome results from persistent vitreoretinal adhesions in the setting of partial posterior vitreous detachment (PVD). Vitrectomy and reattachment of retina is an effective therapeutic approach. The adhesion between vitreous cortex and internal limiting membrane (ILM) of the retina is stronger in youth, which brings difficulties to induce PVD in vitrectomy. Several clinical investigations demonstrated that intravitreous injection of plasmin before vitrectomy could reduce the risk of detachment. In our study, a novel recombinant human microplasminogen (rhμPlg) was expressed by Pichia pastoris. Molecular docking showed that the binding of rhμPlg with tissue plasminogen activator (t-PA) was similar to plasminogen, suggesting rh μPlg could be activated by t-PA to generate microplasmin (μPlm). Moreover, rhμPlg had higher catalytic activity than plasminogen in amidolytic assays. Complete PVD was found at vitreous posterior pole of 125 μg rhμPlg-treated eyes without morphological change of retina in juvenile rabbits via intraocular injection. Our results demonstrate that rhμPlg has a potential value in the treatment of vitreoretinopathy.
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Ach T, Agostini H, Claessens D, Gehrig C, Hattenbach LO, Lommatzsch A, Ostrowski A, Schumann RG. [Macular hole and vitreomacular traction : S1 guideline of the German Society of Ophthalmology (DOG), the German Retina Society (RG) and the German Professional Association of Ophthalmologists (BVA). Version: 22 September 2022]. DIE OPHTHALMOLOGIE 2023; 120:1-14. [PMID: 36512120 DOI: 10.1007/s00347-022-01774-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 12/14/2022]
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Garg A, Ballios BG, Yan P. Spontaneous Closure of an Idiopathic Full-Thickness Macular Hole: A Literature Review. JOURNAL OF VITREORETINAL DISEASES 2022; 6:381-390. [PMID: 37006898 PMCID: PMC9954929 DOI: 10.1177/24741264211049873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This work reviews the literature regarding spontaneous closure of idiopathic full-thickness macular holes (FTMHs). Methods: Literature on patients with spontaneous idiopathic FTMH closure was reviewed via Ovid MEDLINE, EMBASE, and PubMed through July 16, 2020. A total of 27 of 66 identified articles were included. Results: A total of 68 eyes had spontaneous closure. Of the patients, 62.7% were women and the average age was 67.5 years. Visual acuity improved from Snellen 20/78 to 20/33 post closure. The average hole diameter was 176.8 μm; the largest was 350 μm. Most were stage 2 according to Gass and of small size according to International Vitreomacular Traction Study Group (IVTS) staging. The predominant classification system in recent literature is IVTS staging. The average optical coherence tomography–observed closure time was 4.5 months. Conclusions: On review, reported spontaneous closure rates of all idiopathic FTMH range from 3% to 15%, and no demographic subgroups are more likely to have closure. Holes ≤250 µm have higher closure rates (22.2%) than those in the range of >250 to 400 µm (13.3%) and ≥400 µm (0%). Closure is associated with favorable visual outcomes, and retinal bridging via glial cells is likely critical to closure. These determinations were based on limited numbers; prospective studies are needed to further ascertain rate, mechanism, and characteristics. IVTS staging provides reliable reporting and insight into whether FTMH can be observed before surgery.
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Affiliation(s)
- Anubhav Garg
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Brian G. Ballios
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Peng Yan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
- Kensington Vision and Research Centre, Toronto, Canada
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10
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Paul C, Müller HH, Raber T, Bertelmann T. Calculating the individual probability of successful ocriplasmin treatment in eyes with vitreomacular traction–Validation and refinement of a multivariable prediction model. PLoS One 2022; 17:e0270120. [PMID: 35877658 PMCID: PMC9312425 DOI: 10.1371/journal.pone.0270120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 06/05/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose
To evaluate a multivariable model predicting the individual probability of successful intravitreal ocriplasmin (IVO) treatment in eyes with vitreomacular traction (VMT).
Methods
Data from three prospective, multicenter IVO studies (OASIS, ORBIT, and INJECT) were pooled. Patients were included if they were treated for a symptomatic VMT without a full-thickness macular hole. A prediction model for VMT resolution using the factors ‘age’ and ‘horizontal VMT diameter’ was validated by receiver operating characteristic analysis and according to grouped prediction after calibration. Multivariable regression analysis was performed to check robustness and explore further improvements.
Results
Data from 591 eyes was included. In the univariate analysis all key factors (age, gender, VMT diameter, lens status, ERM) significantly correlated to treatment success. The prediction model was robust and clinically applicable to estimate the success rate of IVO treatment (AUC of ROC: 0.70). A refinement of the model was achieved through a calibration process.
Conclusion
The developed multivariable model using ‘horizontal VMT diameter’ and ‘age’ is a valid tool for prediction of VMT resolution upon IVO treatment.
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Affiliation(s)
- Christoph Paul
- Department of Ophthalmology, Philipps-University Marburg, Marburg, Germany
- * E-mail:
| | - Hans-Helge Müller
- Institute of Medical Bioinformatics and Biostatistics, Philipps-University Marburg, Marburg, Germany
| | | | - Thomas Bertelmann
- Thomas Bertelmann M.D., Department of Ophthalmology, University Medical Centre Goettingen, Goettingen, Germany
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Pradhan D, Agarwal L, Joshi I, Kushwaha A, Aditya K, Kumari A. Internal limiting membrane peeling in macular hole surgery. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2022; 20:Doc07. [PMID: 35813123 PMCID: PMC9204259 DOI: 10.3205/000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/23/2021] [Indexed: 11/18/2022]
Abstract
Since the era when macular hole was considered untreatable, macular hole surgery has come a long way to being one of the most successful surgeries. Internal limiting membrane (ILM) peeling has been an essential step of macular hole surgery since the establishment of the role of ILM in the aetiopathogenesis and progression of macular hole. However, the novel technique was not all virtuous. It had some vices which were not evident immediately. With the advent of spectral domain optical coherence tomography, short- and long-term effects of ILM peeling on macular structures were known; and with microperimetry, its effect on the function of macula could be evaluated. The technique has evolved with time from total peeling to inverted flap to just temporal peeling and temporal flap in an attempt to mitigate its adverse effects and to improve its surgical outcome. ILM abrasion technique and Ocriplasmin may eliminate the need of ILM peeling in selected cases, but they have their own limitations. We here discuss the role of ILM in the pathogenesis of macular hole, the benefits and adverse effects of ILM peeling, and the various modifications of the procedure, to then explore the alternatives.
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Affiliation(s)
- Deepti Pradhan
- Kirtipur Eye Hospital, Department of Vitreoretinal Services, Kirtipur, Nepal,*To whom correspondence should be addressed: Deepti Pradhan, Kirtipur Eye Hospital, Department of Vitreoretinal Services, Tahalcha, Tinkune, 44618 Kirtipur-10, Nepal, Phone: +977 9808119112, E-mail:
| | - Lalit Agarwal
- Biratnagar Eye Hospital, Department of Vitreoretinal Services, Biratnagar, Nepal
| | - Ichhya Joshi
- Biratnagar Eye Hospital, Department of Vitreoretinal Services, Biratnagar, Nepal
| | - Anamika Kushwaha
- Biratnagar Eye Hospital, Department of Vitreoretinal Services, Biratnagar, Nepal
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Fouad AN, Eissa IM, Nassar GA, Leila M, Fathy AM. Effect of pneumatic vitreolysis in management of patients with symptomatic focal vitreomacular traction. Int J Retina Vitreous 2022; 8:22. [PMID: 35346391 PMCID: PMC8962114 DOI: 10.1186/s40942-022-00376-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the efficacy of single intravitreal injection of an expansile concentration of sulphur hexafluoride gas (SF6) in treating patients with symptomatic focal vitreomacular traction (VMT) documented by spectral domain optical coherence tomography (SD-OCT) preoperatively. METHODS This is a prospective interventional case series including 30 eyes of 29 patients with symptomatic focal VMT evident on SD-OCT. Pre-operatively, mean best corrected visual acuity (BCVA) was 20/125 (range 20/400-20/40). Mean central foveal thickness (CFT) was 382 μm (range 149-576 μm; SD ± 91.88). All eyes received single intravitreal injection of 0.3 mL of 100% SF6 gas. Postoperatively, we performed SD-OCT at one week, one month, and three months for all eyes. Primary outcome measure was release of VMT. Secondary outcome measures were changes in postoperative BCVA andCFT. RESULTS Overall, VMT release occurred in 24 of 30 eyes by the final follow-up visit (80% final release rate); furthermore, 76.9% of eyes with diabetic maculopathy and 25% of eyes with concurrent epiretinal membrane (ERM) had successful VMT release. VMT release was documented on SD-OCT at an average of 3 weeks (range, 1-12 weeks). The rate of release in phakic eyes was 90% (18 of 20 eyes) versus 60% in pseudophakic eyes (6 of 10 eyes). One patient developed a retinal break at upper nasal retina after two weeks of injection. CONCLUSION Pneumatic vitreolysis (PVL) with limited face-down position is a viable option for treating focal VMT with few adverse events. Further studies are needed to evaluate its indications, benefits, and risks.
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Affiliation(s)
- Ahmed N Fouad
- Retina Department, Research Institute of Ophthalmology, 2 Al Ahram st., Giza, Egypt.
| | - Iman M Eissa
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ghada A Nassar
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud Leila
- Retina Department, Research Institute of Ophthalmology, 2 Al Ahram st., Giza, Egypt
| | - Adel M Fathy
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
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13
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Thomas AS, Duchateau L, Kozma-Wiebe P, Jaffe G. Resolution of outer retinal abnormalities in eyes with vitreomacular traction without macular hole in the OASIS trial. Br J Ophthalmol 2022:bjophthalmol-2021-319500. [PMID: 35288439 DOI: 10.1136/bjophthalmol-2021-319500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 02/16/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To describe the clinical impact of external limiting membrane (ELM) disruption, ellipsoid zone (EZ) disruption and subretinal fluid (SRF) seen on optical coherence tomography (OCT) in eyes with vitreomacular traction (VMT) without macular hole (MH) in the Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion Including Macular Hole study. METHODS Phase 3b randomised double-blind sham-controlled multicentre study including 144 eyes with VMT without MH. Eyes were randomised to receive a single intravitreal injection of ocriplasmin or sham injection and were followed for 24 months. Eyes were analysed for presence, course and clinical impact of ELM disruption, EZ disruption and SRF on OCT. RESULTS ELM disruption, EZ disruption and SRF were present in 32.6%, 52.2% and 45.8% of ocriplasmin-treated eyes and 39.6%, 42.6% and 37.5% of sham-treated eyes at baseline. VMT resolution was associated with resolution of ELM and EZ disruption and SRF. A small number of eyes had persistent ELM disruption, EZ disruption and/or SRF at the seventh visit or later (17 months or later) following medical or surgical VMT resolution. Resolution of ELM disruption, EZ disruption and/or SRF was associated with an improvement of visual acuity from baseline. Following VMT resolution, ELM recovery usually preceded EZ recovery and SRF resolution. CONCLUSIONS ELM disruption, EZ disruption and/or SRF are present in a significant percentage of eyes with VMT without MH. Release of VMT is usually associated with outer retinal recovery and an associated improvement in visual acuity. ELM recovery typically precedes EZ recovery and SRF resolution following VMT release.
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Affiliation(s)
| | - Luc Duchateau
- Biometrics Research Centre, Ghent University, Gent, Belgium
| | | | - Glenn Jaffe
- Ophthalmology, Duke Medicine, Durham, North Carolina, USA
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Zhang W, Zhao X, Meng L, Wang D, Feng S, Chen Y. The efficacy and safety of ocriplasmin for patients with vitreous macular traction. Acta Ophthalmol 2022; 100:e304-e313. [PMID: 34021702 DOI: 10.1111/aos.14867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/01/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To estimate the efficacy and safety of ocriplasmin for patients with vitreous macular traction (VMT). METHODS The PubMed, EMBASE and Ovid were searched up to May 2020 to identify related studies. Statistical analysis was conducted by R software version 3.6.3. Results in proportion with 95% confidence interval (CI) were calculated by means of Freeman-Tukey variant of arcsine square transformation. RESULTS The pooling results indicated the overall complete release rate was 50% (95% CI [45%-54%]). For VMT patients younger than 65 years old, with smaller adhesion size of VMT (<1500 μm), phakic eyes, with macular hole (MH) and subretinal fluid (SRF), while without epiretinal membrane (ERM), ocriplasmin could achieve much higher complete release rates than those under opposite conditions. The general nonsurgical closure rate of MH was 34% (95% CI [30%-37%]), and it was positively correlated with the MH size. The visual improvement rate was 45% (95% CI [32%-59%]), and it was higher for patients with VMT resolution (59%, 95% CI [41%-75%]). The secondary pars plana vitrectomy (PPV) rate for patients without MH closure or VMT resolution was about 31% (95% CI [23%-39%]). The incidence of MH progression was 10% (95% CI [4%-18%]), and other severe adverse events such as endophthalmitis, retinal detachment and retinal tear were relatively rare. CONCLUSION Ocriplasmin is an effective, reliable and relatively safe intervention for the treatment of VMT. The most suitable candidates were patients younger than 65 years old, with smaller adhesion size (<1500 μm), phakic eyes, with MH and SRF, while without ERM.
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Affiliation(s)
- Wen‐Fei Zhang
- Department of Ophthalmology Peking Union Medical, College Hospital Chinese Academy of Medical Sciences Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Xin‐Yu Zhao
- Department of Ophthalmology Peking Union Medical, College Hospital Chinese Academy of Medical Sciences Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Li‐Hui Meng
- Department of Ophthalmology Peking Union Medical, College Hospital Chinese Academy of Medical Sciences Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Dong‐Yue Wang
- Department of Ophthalmology Peking Union Medical, College Hospital Chinese Academy of Medical Sciences Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - Shi Feng
- Department of Ophthalmology Peking Union Medical, College Hospital Chinese Academy of Medical Sciences Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
| | - You‐Xin Chen
- Department of Ophthalmology Peking Union Medical, College Hospital Chinese Academy of Medical Sciences Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
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15
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Chen X, Li M, You R, Wang W, Wang Y. Efficacy and Safety of Ocriplasmin Use for Vitreomacular Adhesion and Its Predictive Factors: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 8:759311. [PMID: 35096864 PMCID: PMC8793778 DOI: 10.3389/fmed.2021.759311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/13/2021] [Indexed: 12/03/2022] Open
Abstract
Symptomatic vitreomacular adhesion (sVMA) impedes visual acuity and quality. Ocriplasmin is a recombinant protease, which may be injected into the vitreous cavity to treat this condition, yet controversy remains with respect to its effectiveness and safety, particularly its patient selection standard. In this systematic review, the PubMed, Embase, and the Cochrane Library were searched to identify studies published prior to August 2020 on the impact of ocriplasmin treatment on VMA release, macular hole (MH) closure, and/or related adverse events (AEs). Data were pooled using a random-effects model. Risk ratios (RRs) with 95% CIs were calculated. Of 1,186 articles reviewed, 5 randomized controlled trials and 50 cohort studies were ultimately included, representing 4,159 patients. Ocriplasmin significantly increased the rate of VMA release (RR, 3.61; 95% CI, 1.99–6.53; 28 days after treatment) and MH closure (RR, 3.84; 95% CI, 1.62–9.08; 28 days after treatment) and was associated with visual function improvement. No increased risk for overall AEs was seen in ocriplasmin treatment. The proportion of VMA release and MH closure in patients was 0.50 and 0.36, respectively. VMA release was more likely in patients with absence of epiretinal membrane (ERM). Patients with smaller MH diameter were more likely to achieve MH closure. Evidence from included studies suggests that ocriplasmin is a suitable and safe approach for treating sVMA. ERM and MH status are important factors when considering ocriplasmin treatment.
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Affiliation(s)
- Xi Chen
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Min Li
- Clinical Epidemiology and Evidence-Based Medicine (EBM) Unit, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ran You
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yanling Wang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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16
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Grant S, Adrean SD. Surgical Macular Hole Closure Without a Gas Tamponade. JOURNAL OF VITREORETINAL DISEASES 2022; 6:14-21. [PMID: 37007721 PMCID: PMC9976217 DOI: 10.1177/24741264211018958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This work aims to evaluate the outcomes of a series of macular hole (MH) surgical procedures in patients who had pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peel and without gas tamponade. Methods: Patients from a retina specialty clinic who had MHs were identified for this interventional case series. Patients with small MHs were offered inclusion into the trial. Patients with larger MHs were excluded. They underwent standard 3-port PPV and ILM peel without gas or air to treat small MHs. The main outcomes that we measured were closure of MH and visual results. Results: Small MHs in 5 patients were managed with PPV and ILM peel alone. The average preoperative hole size at its narrowest width was 227 µm (range, 173-294 µm). Four of 5 patients (80%) had successful hole closure without a gas tamponade and improved vision; 1 patient did not have hole closure and was treated with an in-office gas bubble to close the hole. The average preoperative vision at 3 months was 20/80– (54 Early Treatment Diabetic Retinopathy Study [ETDRS] letters) and improved to 20/30–2 (73 ETDRS letters) in the 4 patients whose MHs were closed with surgery without a gas bubble. This was statistically significant ( P = .003). The hole that did not close initially without gas tamponade was the largest in the series. Conclusions: Patients with small MHs can be successfully treated with a vitrectomy and ILM peel alone without a gas tamponade.
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Affiliation(s)
- Scott Grant
- Retina Consultants of Orange County, Fullerton, CA, USA
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17
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Baumann C, Sabatino F, Zheng Y, Johannigmann-Malek N, Maier M, Kaye SB, Patton N. Anatomical and functional outcomes of pneumatic vitreolysis for treatment of vitreomacular traction with and without macular holes. Graefes Arch Clin Exp Ophthalmol 2022; 260:2209-2215. [PMID: 35122133 PMCID: PMC9203395 DOI: 10.1007/s00417-022-05568-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/06/2022] [Accepted: 01/14/2022] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To evaluate the outcome of pneumatic vitreolysis (PVL) for vitreomacular traction (VMT) with or without full thickness macular hole (MH) < 400 µm. METHODS Forty-seven eyes of 47 patients were included who had undergone PVL for VMT with or without MH. Main outcome measures were release of VMT, MH closure, best-corrected visual acuity (BCVA) and adverse events. RESULTS Thirty-three patients had isolated VMT and 14 patients VMT with a MH. Four weeks after PVL, the overall VMT release rate was 35/47 (74.5%): 25/37 (67.6%) in phakic and 10/10 (100%) in pseudophakic eyes (p = 0.03). Four of 14 MH (28.6%) were closed. Twenty-two of 47 (46.8%) eyes required a subsequent PPV: 12/33 (36.4%) in the VMT only group and 10/14 (71.4%) in the VMT with MH group. Mean BCVA improved from 0.48 (± 0.24) to 0.34 (± 0.23) logMAR at 6 months in patients with VMT alone (p < 0.001), and from 0.57 (± 0.27) to 0.41 (± 0.28) logMAR in patients with VMT and MH (p = 0.008). Adverse events included new formation of a large MH in 4/33 (12.1%) eyes, failure of MH closure in 10/14 (71.4%) eyes, progression of mean minimum linear diameter (MLD) MH size from baseline 139 (± 67) to 396 (± 130) µm (p < 0.001) and development of a retinal detachment in 4/47 (8.5%) eyes. CONCLUSION While PVL leads to a high VMT release rate particularly in pseudophakic eyes, it is associated with a relatively high incidence of MH formation, MH size progression and retinal detachment.
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Affiliation(s)
- Carmen Baumann
- Ophthalmology Department, Hospital rechts der Isar, Technical University of Munich (TUM), Ismaninger Str. 22, 81675 Munich, Germany
| | | | - Yalin Zheng
- University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX UK
| | - Navid Johannigmann-Malek
- Ophthalmology Department, Hospital rechts der Isar, Technical University of Munich (TUM), Ismaninger Str. 22, 81675 Munich, Germany
| | - Mathias Maier
- Ophthalmology Department, Hospital rechts der Isar, Technical University of Munich (TUM), Ismaninger Str. 22, 81675 Munich, Germany
| | - Stephen B. Kaye
- University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX UK
| | - Niall Patton
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL UK
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18
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Neffendorf JE, Kirthi V, Soare C, Jackson TL. The Effect of Intravitreal Ocriplasmin on Hue Discrimination. Optom Vis Sci 2021; 98:1394-1399. [PMID: 34905526 DOI: 10.1097/opx.0000000000001811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE We report 13 patients who received ocriplasmin for symptomatic vitreomacular adhesion. Farnsworth-Munsell 100 (FM 100) hue test total error score (TES) increased from baseline to month 1, before recovering at year 1. Ocriplasmin may alter hue discrimination. PURPOSE This study aimed to determine whether intravitreal ocriplasmin affects hue discrimination. METHODS Thirteen patients with symptomatic vitreomacular adhesion received intravitreal ocriplasmin 125 μg. Patients underwent full ocular examination, optical coherence tomography, and FM 100 hue test at baseline, 1 week, 1 month, and 1 year. RESULTS Mean age was 74.8 years. The median baseline FM 100 TES was similar in the injected and fellow eyes (272 vs. 252, respectively). Median TES in the injected eye increased from 272 to 348 at 1 week (median difference compared with baseline, +52.0; 98.8% confidence interval of difference, -64.0 to 184.0; P = .29), decreased to 324 at 1 month (median difference compared with baseline, -4.0; 98.8% confidence interval of difference, -44.0 to 256.0; P = .40), and decreased to 268 at 1 year (median difference compared with baseline, -108.0; 93.8% confidence interval of difference, -200.0 to 52.0; P = .19). Two patients (15.4%) had anatomic release of vitreomacular adhesion, occurring within 1 month of injection. CONCLUSIONS Ocriplasmin may alter hue discrimination, but larger studies are required to provide sufficient power to detect or exclude a statistically significant effect. Longer follow-up is needed to determine the duration of any effect.
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Affiliation(s)
- James E Neffendorf
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | | | - Cristina Soare
- Department of Ophthalmology, King's College Hospital, London, United Kingdom
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19
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Al-Nawaiseh S, Rickmann A, Seuthe AM, Al-Rimawi D, Viktor Stanzel B, Szurman P. REVISED PREDICTIVE BIOMARKER FOR OCRIPLASMIN THERAPY IN VITREOMACULAR TRACTION DISORDERS. Retina 2021; 41:2549-2555. [PMID: 34173361 DOI: 10.1097/iae.0000000000003244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine a statistically optimal limit of adhesion size in vitreomacular traction (VMT) syndrome for ocriplasmin treatment. METHODS In this retrospective, consecutive, interventional study, we included 106 patients treated with ocriplasmin injection because of VMT between July 2013 and January 2018. A univariate and multivariate risk analysis was performed with grouped factors and continuous factors. We used a receiver operating characteristic curve to measure the prognostic relevance of each continuous factor for therapy success and determined the statistically optimal cutoff value at which specificity and sensitivity are simultaneously maximized. RESULTS Among the grouped factors, only a phakic lens status showed a highly significant positive influence on the resolution of the VMT. For the continuous factors, only the adhesion diameter before injection was a good predictor of anatomical success. The statistically optimal threshold value for the adhesion size was calculated to be 480 µm. Eyes below this limit had a 6.84-fold better chance of VMT resolution compared with eyes with a larger adhesion diameter. CONCLUSION The threshold value of the VMT diameter for ocriplasmin therapy could be statistically defined as 480 µm and may thus be a new quantitative biomarker to predict treatment success.
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Affiliation(s)
- Sami Al-Nawaiseh
- Department of ophthalmology, Eye Clinic Sulzbach, Knappschaftsklinikum Saar, Sulzbach, Germany
| | - Annekatrin Rickmann
- Department of ophthalmology, Eye Clinic Sulzbach, Knappschaftsklinikum Saar, Sulzbach, Germany
- Department of ophthalmology, Klaus Heimann Eye Research Institute (KHERI), Sulzbach, Germany; and
| | - Anna-Maria Seuthe
- Department of ophthalmology, Eye Clinic Sulzbach, Knappschaftsklinikum Saar, Sulzbach, Germany
| | - Dalia Al-Rimawi
- Biostatistics Unit, Research Office, King Hussein Cancer Foundation and Center, Center for Research Shared Resources, Bio-statistics and Data Science, Amman, Jordan
| | - Boris Viktor Stanzel
- Department of ophthalmology, Eye Clinic Sulzbach, Knappschaftsklinikum Saar, Sulzbach, Germany
- Department of ophthalmology, Klaus Heimann Eye Research Institute (KHERI), Sulzbach, Germany; and
| | - Peter Szurman
- Department of ophthalmology, Eye Clinic Sulzbach, Knappschaftsklinikum Saar, Sulzbach, Germany
- Department of ophthalmology, Klaus Heimann Eye Research Institute (KHERI), Sulzbach, Germany; and
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20
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Wang L, Yao L, Duan H, Yang F, Lin M, Zhang R, He Z, Ahn J, Fan Y, Qin L, Gong Y. Plasminogen Regulates Fracture Repair by Promoting the Functions of Periosteal Mesenchymal Progenitors. J Bone Miner Res 2021; 36:2229-2242. [PMID: 34378815 PMCID: PMC8865375 DOI: 10.1002/jbmr.4423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/06/2022]
Abstract
Defective or insufficient bone repair and regeneration are common in patients as a result of major trauma or severe disease. Cell therapy with periosteal mesenchymal progenitors, which can be limited in severe injury, serves as a promising approach; however, its efficacy is limited due to a repair-hostile ischemic tissue microenvironment after traumatic fracture. Here we report that plasminogen (Plg), a factor that is upregulated in these environments, is critical for fracture healing. Plg knockout mice had impaired trabecular and cortical bone structure and exhibited delayed and incomplete fracture healing. Interestingly, Plg deficiency greatly reduced the thickness of expanded periosteum, suggesting a role of Plg in periosteal mesenchymal progenitor-mediated bone repair. In culture, Plg increased cell proliferation and migration in periosteal mesenchymal progenitors and inhibited cell death under ischemic conditions. Mechanistically, we revealed that Plg cleaved and activated Cyr61 to regulate periosteal progenitor function. Thus, our study uncovers a cellular mechanism underlying fracture healing, by which Plg activates Cyr61 to promote periosteal progenitor proliferation, survival, and migration and improves bone repair after fracture. Targeting Plg may offer a rational and effective therapeutic opportunity for improving fracture healing. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Luqiang Wang
- Departments of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Orthopaedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lutian Yao
- Departments of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Orthopaedics, The First Hospital of China Medical University, Shenyang, China
| | - Hao Duan
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurosurgery, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Fan Yang
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Maohuan Lin
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rongxin Zhang
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Zhenqiang He
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jaimo Ahn
- Departments of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yi Fan
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ling Qin
- Departments of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yanqing Gong
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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21
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Chan CK, Mein CE, Glassman AR, Beaulieu WT, Calhoun CT, Jaffe GJ, Jampol LM, MacCumber MW, Maguire MG, Maturi RK, Salehi-Had H, Rofagha S, Sun JK, Martin DF. Pneumatic Vitreolysis with Perfluoropropane for Vitreomacular Traction with and without Macular Hole: DRCR Retina Network Protocols AG and AH. Ophthalmology 2021; 128:1592-1603. [PMID: 33989683 PMCID: PMC8545749 DOI: 10.1016/j.ophtha.2021.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate pneumatic vitreolysis (PVL) in eyes with vitreomacular traction (VMT) with and without full-thickness macular hole (FTMH). DESIGN Two multicenter (28 sites) studies: a randomized clinical trial comparing PVL with observation (sham injection) for VMT without FTMH (Protocol AG) and a single-arm study assessing PVL for FTMH (Protocol AH). PARTICIPANTS Participants were adults with central VMT (vitreomacular adhesion was ≤3000 μm). In Protocol AG, visual acuity (VA) was 20/32 to 20/400. In Protocol AH, eyes had a FTMH (≤250 μm at the narrowest point) and VA of 20/25 to 20/400. METHODS Pneumatic vitreolysis using perfluoropropane (C3F8) gas. MAIN OUTCOME MEASURES Central VMT release at 24 weeks (Protocol AG) and FTMH closure at 8 weeks (Protocol AH). RESULTS From October 2018 through February 2020, 46 participants were enrolled in Protocol AG, and 35 were enrolled in Protocol AH. Higher than expected rates of retinal detachment and tear resulted in early termination of both protocols. Combining studies, 7 of 59 eyes (12% [95% CI, 6%-23%]; 2 eyes in Protocol AG, 5 eyes in Protocol AH) that received PVL developed rhegmatogenous retinal detachment (n = 6) or retinal tear (n = 1). At 24 weeks in Protocol AG, 18 of 23 eyes in the PVL group (78%) versus 2 of 22 eyes in the sham group (9%) achieved central VMT release without rescue vitrectomy (adjusted risk difference, 66% [95% CI, 44%-88%]; P< 0.001). The mean change in VA from baseline at 24 weeks was 6.7 letters in the PVL group and 6.1 letters in the sham group (adjusted difference, -0.8 [95% CI, -6.1 to 4.5]; P = 0.77). In Protocol AH, 10 of 35 eyes (29% [95% CI, 16%-45%]) achieved FTMH closure without rescue vitrectomy at 8 weeks. The mean change in VA from baseline at 8 weeks was -1.5 letters (95% CI, -10.3 to 7.3 letters). CONCLUSIONS In most eyes with VMT, PVL induced hyaloid release. In eyes with FTMH, PVL resulted in hole closure in approximately one third of eyes. These studies were terminated early because of safety concerns related to retinal detachments and retinal tears.
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Affiliation(s)
- Clement K Chan
- Southern California Desert Retina Consultants, Palm Desert, California
| | - Calvin E Mein
- Retinal Consultants of San Antonio, San Antonio, Texas
| | | | | | | | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Lee M Jampol
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Maureen G Maguire
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Hani Salehi-Had
- Retina Associates of Southern California, Huntington Beach, California
| | - Soraya Rofagha
- East Bay Retina Consultants, Oakland, California, and Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Jennifer K Sun
- Joslin Diabetes Center, Beetham Eye Institute, Department of Ophthalmology, Harvard University, Boston, Massachusetts
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22
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Furino C, Niro A, Sborgia L, Reibaldi M, Boscia F, Alessio G. Visual functional changes after ocriplasmin injection for vitreomacular traction: A microperimetric analysis. Taiwan J Ophthalmol 2021; 11:259-265. [PMID: 34703741 PMCID: PMC8493980 DOI: 10.4103/tjo.tjo_57_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/19/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE: The purpose is to evaluate functional changes after ocriplasmin injection to treat vitreomacular traction (VMT) by microperimetry. MATERIALS AND METHODS: Prospective interventional study on patients underwent an intravitreal ocriplasmin injection. Optical coherence tomography, best-corrected visual acuity (BCVA) test, and microperimetry were performed at baseline, 1 week, 1 and 3 months. Microperimeter recorded retinal sensitivity (RS) and central retinal sensitivity (CRS) at central 12° and 4°, respectively, and fixation as bivariate contour ellipse area (BCEA) at 68%, 95%, and 99% of fixation points. Functional parameters were analyzed in patients who had (Group A) or not (Group B) VMT release. RESULTS: Twenty-one patients including 18 with VMT and 3 with VMT plus macular hole (MH) were treated. Eleven patients achieved VMT resolution including all cases with MH that achieved hole closure. An impairment of BCVA, RS and CRS (P < 0.01; P < 0.001; P = 0.001, respectively) was reported at 1 week followed by a significant improvement (BCVA, P = 0.001; RS, CRS, P = 0.02) at 3 months. The early impairment of visual acuity and sensitivity significantly occurred in Group B (P ≤ 0.01) while their recovery significantly occurred in Group A (P < 0.01). BCEA significantly increased in dimension (68%, P = 0.01; 95%, P = 0.03) at 1 week, subsequently returning to near baseline values over follow-up. Only in Group A, fixation stability significantly improved at 3 months. CONCLUSION: Microperimetry confirms an early and reversible functional impairment after ocriplasmin injection regardless VMT resolution. If a greater decrease in function could occur in the eyes without VMT resolution, a better functional recovery could occur in the event of VMT resolution.
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Affiliation(s)
- Claudio Furino
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital "S. G. MOSCATI", ASL TA, Taranto, Italy
| | - Luigi Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | | | - Francesco Boscia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Giovanni Alessio
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
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23
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Ocriplasmin for treatment of vitreomacular traction and macular hole: A systematic literature review and individual participant data meta-analysis of randomized, controlled, double-masked trials. Surv Ophthalmol 2021; 67:697-711. [PMID: 34480895 DOI: 10.1016/j.survophthal.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 11/20/2022]
Abstract
Ocriplasmin is used to treat vitreomacular traction (VMT), with or without full-thickness macular hole (MH). We systematically reviewed the evidence on ocriplasmin's effect on vitreomacular adhesion resolution (VMAR), MH closure, vitrectomy, and best-corrected visual acuity (BCVA) and investigated the effect of baseline covariates on outcome. We applied individual participant data meta-analyses to the entire population and to subgroups defined by MH or epiretinal membrane (ERM) presence. Safety data were pooled and tabulated. Five randomized controlled trials (1,067 participants) were included. Six months after treatment, ocriplasmin achieved higher rates of VMAR and MH closure versus control, lowered vitrectomy odds, and increased the likelihood of a ≥10-letter BCVA increase. VMAR rates were lower when ERM, broad VMA (> 1500 µm), diabetic retinopathy, or pseudophakia were present and higher in younger participants, women, and eyes with MHs. Ocriplasmin-treated participants experienced more short-term visual impairment that was not predictive of final BCVA, as well as vitreous floaters, photopsia, photophobia, eye pain, blurred vision, and dyschromatopsia. The most common serious adverse events for ocriplasmin and control, respectively, were MH progression (22.5%, 17.3%), new MH (1.5%, 3.4%) and retinal detachment (0.8%, 1.2%). Ocriplasmin promotes VMAR and MH closure. Transient visual phenomena are not uncommon.
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24
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Khanani AM, Constantine RN, Blot KH, Lescrauwaet B, Szurman P. Effectiveness of ocriplasmin in real-world settings: A systematic literature review, meta-analysis, and comparison with randomized trials. Acta Ophthalmol 2021; 99:e823-e836. [PMID: 33369248 PMCID: PMC8518696 DOI: 10.1111/aos.14686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/06/2020] [Accepted: 10/25/2020] [Indexed: 11/29/2022]
Abstract
Purpose Effectiveness of ocriplasmin for vitreomacular traction (VMT) varies depending on the presence of common ocular conditions and patient selection criteria. We carried out a systematic literature review and meta‐analysis of ocriplasmin studies conducted in real‐world settings (RWS) and compared outcomes with those from randomized controlled trials (RCTs). Methods We included prospective and retrospective studies from RWS documenting effectiveness of ocriplasmin in patients with VMT with or without MH, and RCTs of ocriplasmin versus control. Key end‐points were vitreomacular adhesion resolution (VMAR), nonsurgical MH closure, need for vitrectomy and safety. We conducted meta‐regression on pooled results to evaluate effects of baseline covariates and study design on outcomes. Results Thirty RWS (2402 patients) and 5 RCTs (737 patients) were included epiretinal membrane (ERM) and broad VMA were more prevalent in RCTs. Primary VMAR, vitrectomy and MH closure rates were comparable between RWS and RCTs. Rates of nsVMAR were significantly higher in RWS than RCTs (odds ratio 1.66; 95% confidence interval [CI]: 1.18–2.34). nsVMAR rates were inversely associated with ERM prevalence (odds ratio 0.20; 95% CI: 0.08–0.51). Compared with the recent OASIS trial, RWS reported a higher incidence of new/worsening subretinal fluid cases and less photophobia, photopsia, vitreous floaters, electroretinogram abnormalities and MH progression. Conclusions Ocriplasmin was significantly more effective in achieving nsVMAR in RWS than in RCTs. Lower ERM prevalence in RWS was the single significant explanatory variable for this difference. Conclusions on ocriplasmin safety in RWS are limited due to inconsistent reporting.
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Affiliation(s)
| | | | | | | | - Peter Szurman
- Eye Clinic Sulzbach Knappschaft Hospital Saar Sulzbach Germany
- Klaus Heimann Eye Research Institute (KHERI) Sulzbach Germany
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Silva N, Ferreira A, Nawrocka (vel Michalewska) ZA, Meireles A. Inverted Internal Limiting Membrane Flap Technique: Is It the Best Option for Macular Holes? Clin Ophthalmol 2021; 15:3295-3303. [PMID: 34408388 PMCID: PMC8360769 DOI: 10.2147/opth.s284614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Surgical treatment is generally necessary to repair full-thickness macular holes (FTMH). Although vitrectomy with or without internal limiting membrane (ILM) peeling remains the standard surgical technique, the inverted ILM flap procedure has increasingly assumed a role in the primary surgical repair of FTMHs. Some vitreoretinal surgeons reserve this technique to treat large or myopic holes, whereas others use it routinely in all cases. This paper is a comprehensive review of the current scientific evidence on the anatomical and functional outcomes of the inverted ILM flap technique in the repair of macular holes, following the International Vitreomacular Traction Study (IVTS) group classification.
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Affiliation(s)
- Nisa Silva
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal
| | - André Ferreira
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, 4200-319, Portugal
| | | | - Angelina Meireles
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal
- Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, 4050-313, Portugal
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Drenser KA, Pieramici DJ, Gunn JM, Rosberger DF, Kozma P, Fineman MS, Duchateau L, Khanani AM. Retrospective Study of Ellipsoid Zone Integrity Following Treatment with Intravitreal Ocriplasmin (OZONE Study). Clin Ophthalmol 2021; 15:3109-3120. [PMID: 34295149 PMCID: PMC8291832 DOI: 10.2147/opth.s285464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 06/28/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess generalized (GD) and focal ellipsoid zone disruption (FD) in patients with symptomatic vitreomacular adhesion (sVMA) using spectral domain optical coherence tomography (SD-OCT) following ocriplasmin. Patients and methods OZONE was a Phase 4, retrospective study of patients with sVMA treated with a single intravitreal injection of ocriplasmin (0.125 mg). Data from adult patients with at least 6-month follow-up after ocriplasmin were included. SD-OCT was performed at baseline (within 30 days before ocriplasmin), before Day 21 post-injection (early observation, EO), and by last observation (LO) which was maximally 6 months post-injection. The main outcome measure was the development of new and the evolution of existing FD/GD at EO and LO. Results The study enrolled 134 eyes/patients from 22 sites in the USA. At baseline, 87 eyes (64.9%) had FD, 21 eyes (15.7%) had GD and 26 eyes (19.4%) had no FD/GD. Among the eyes without FD/GD at baseline, 13 (50%) and 8 (30.8%) developed FD or GD, respectively, by EO. By LO, FD/GD improvement or resolution was seen in >80% of these eyes. Among the eyes with FD/GD at baseline, <40% had improving/resolving EZ integrity at LO. The absence of FD/GD at baseline was associated with less persistent FD/GD at LO (P<0.0005). The presence of FD with MH at baseline was associated with persistent FD at LO (P=0.027). Conclusion The fact that a large majority of eyes had FD/GD prior to ocriplasmin was unexpected and demonstrates that EZ disruptions are common in sVMA. This suggests that loss of EZ integrity may be part of the natural history of this disorder. It is hypothesized that the status of the EZ at baseline is a contributing, ocriplasmin independent modulator of subsequent EZ changes after ocriplasmin. Prospective analyses which include a sham control group would be required to test this hypothesis.
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Affiliation(s)
| | - Dante J Pieramici
- California Retina Consultants, Santa Barbara, CA, USA.,California Retina Research Foundation, Santa Barbara, CA, USA
| | | | | | - Petra Kozma
- Oxurion NV (formerly ThromboGenics NV), Leuven, Belgium
| | - Mitchell S Fineman
- Mid Atlantic Retina, Philadelphia, PA, USA.,Wills Eye Hospital, Philadelphia, PA, USA
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PATIENT-REPORTED VISUAL FUNCTION FROM THE OCRIPLASMIN FOR TREATMENT FOR SYMPTOMATIC VITREOMACULAR ADHESION, INCLUDING MACULAR HOLE (OASIS) STUDY. Retina 2021; 40:1331-1338. [PMID: 31259807 PMCID: PMC7302331 DOI: 10.1097/iae.0000000000002599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text. Symptomatic vitreomacular adhesion is associated with reduced visual acuity, which can significantly affect quality of life. This study was a prespecified analysis of the 2-year, sham-controlled OASIS trial. Clinically meaningful (≥5-point) changes in patient-reported outcomes were assessed. Ocriplasmin resulted in clinically meaningful improvements in visual function. Purpose: To evaluate patient-reported visual function after ocriplasmin through the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) in patients with symptomatic vitreomacular adhesion/vitreomacular traction including macular hole. Methods: This was a prespecified analysis of a secondary endpoint from the OASIS trial. Patients received a single intravitreal injection of ocriplasmin (0.125 mg) or sham and completed the VFQ-25 questionnaire at baseline and at Months 6, 12, and 24. Clinically meaningful (≥5-point) changes from baseline were assessed. Results: Of the 220 patients enrolled, 146 received ocriplasmin and 74 received sham. At Month 24, the percentage of patients with a ≥5-point improvement from baseline in VFQ-25 composite scores was higher with ocriplasmin versus sham (51.4% vs. 30.1%, 95% confidence interval, 8.1–34.5, P = 0.003). The percentage of patients with ≥5-point worsening at Month 24 was lower with ocriplasmin versus sham (9.5% vs. 15.6%, 95% confidence interval: −15.6 to 3.5, P = 0.191). A larger percentage of patients treated with ocriplasmin versus sham experienced a ≥5-point improvement in VFQ-25 composite and subscale scores at Month 24 regardless of baseline full-thickness macular hole status. Conclusion: A larger percentage of patients with symptomatic vitreomacular adhesion/vitreomacular traction reported clinically meaningful improvements in self-assessed visual function with ocriplasmin than sham.
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Velaga SB, Nittala MG, Ip MS, Duchateau L, Sadda SR. Post hoc analysis of ellipsoid zone changes beyond the central subfield in symptomatic vitreomacular adhesion patients from the OASIS trial. BMJ Open Ophthalmol 2021; 6:e000648. [PMID: 34250257 PMCID: PMC8217951 DOI: 10.1136/bmjophth-2020-000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background/aims OASIS is a Phase IIIb trial (NCT01429441) assessing long-term outcomes in subjects with symptomatic vitreomacular adhesion (VMA). The purpose of this study is to report on the frequency, severity, location and time course of ellipsoid zone (EZ) alterations in ocriplasmin-treated and sham control eyes in the OASIS study. Methods 220 patients (146 ocriplasmin, 74 sham) subjects with VMA were enrolled in this masked post hoc analysis phase IIIb, randomised, sham-controlled double-masked multicentre clinical trial. A masked post hoc analysis of OCT images was performed at the Doheny Image Reading Center from subjects enrolled in the OASIS trial. The status of the EZ band was assessed in three different macular regions: the central subfield (CS) (≤1 mm diameter), the parafoveal area (PAA) (>1 to ≤3 mm) and the perifoveal area (PEA) (>3 to ≤6 mm). The EZ band was rated as normal/intact, full thickness macular hole (FTMH), abnormal but continuous, discontinuous/disrupted or absent at visits from baseline (pretreatment) to week 1 (day 7), month 1 (day 28), month 3, month 6, month 12 and the final follow-up at month 24. EZ band status was compared in both study and control eyes. Results A total of 208 patients (138 ocriplasmin, 70 sham) were included in this analysis. At baseline, FTMH was present in 48.6%, 8.0%, 0% and 52.8%, 2.9%, 0% in the CS, PAA and PEA of the ocriplasmin and sham groups, respectively. The EZ was graded to be abnormal but continuous, discontinuous/disrupted or absent at Baseline in 21.0%, 4.3%, 2.8% in the CS, PAA and PEA, respectively, of the ocriplasmin group; and 12.9%, 10.0%, 4.3% in the CS, PAA and PEA of the sham group. For the ocriplasmin group in the PAA, this frequency increased to 6.6% at week 1, was 9.8% at month 1, but improved to 3.8% at month 3, and remained stable to 1.6% at month 24. These differences, however, were not statistically significant. Conclusions Ocriplasmin treatment for symptomatic VMA was associated with EZ abnormalities in a small percentage of patients that was best assessed in regions (PEA) relatively unaffected by the VM interface disease at baseline. The EZ abnormalities were apparent by week 1, persisted at month 1, and appeared to resolve in the majority of cases by month 3. Trial registration number NCT01429441
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Affiliation(s)
- Swetha Bindu Velaga
- Retina, Doheny Eye Institute, Los angeles, California, USA.,Ophthalmology, Doheny Eye Institute, University of California Los Angeles, Los Angeles, California, USA
| | - Muneeswar Gupta Nittala
- Ophthalmology, Doheny Eye Institute, University of California Los Angeles, Los Angeles, California, USA.,Ophthalmology, University of California Los Angeles David Geffen School of Medicine, Pasadena, California, USA
| | - Michael S Ip
- Ophthalmology, University of California Los Angeles David Geffen School of Medicine, Pasadena, California, USA
| | - Luc Duchateau
- Biometrics Research Centre, Ghent University, Gent, Belgium
| | - SriniVas R Sadda
- Retina, Doheny Eye Institute, Los angeles, California, USA.,Ophthalmology, University of California Los Angeles David Geffen School of Medicine, Pasadena, California, USA.,Ophthalmology, University of California - Los Angeles, Los Angeles, California, USA
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CLOSURE OF SMALL MACULAR HOLES USING VITRECTOMY SURGERY WITH INTERNAL LIMITING MEMBRANE PEELING WITHOUT THE USE OF INTRAOCULAR GAS TAMPONADE: BROADENING THE UNDERSTANDING OF THE MACULAR HOLE PATHOPHYSIOLOGY. Retin Cases Brief Rep 2021; 14:104-109. [PMID: 31469775 DOI: 10.1097/icb.0000000000000919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether small macular hole closure can be achieved with 25-G vitrectomy surgery with internal limiting membrane peeling without the use of intraocular gas tamponade or facedown positioning. METHODS 25-G vitrectomy surgery with internal limiting membrane peeling without the use of intraocular gas tamponade or positioning was performed on 20 eyes with a small (<400-µm diameter), full-thickness macular hole. RESULTS In 17 of 20 eyes (85%), the hole had closed. Three holes had closed by Postoperative Day 1, 13 holes by Postoperative Week 1, 16 holes by Postoperative Week 2, and 17 holes by Postoperative Week 6. At Postoperative Month 1, vision improved in 16 of 17 eyes in which the macular hole had closed. One hole that had not closed at the first postoperative week and two holes that had not closed at the third postoperative week required follow-up surgery with intraocular gas tamponade and facedown positioning, after which the hole closed. The mean preoperative visual acuity was 0.626 logMAR (20/85), and the mean postoperative visual acuity after 1 month was 0.392 logMAR (20/50) (P < 0.001). CONCLUSION Vitrectomy surgery with internal limiting membrane peeling without the use of gas tamponade or positioning can achieve closure of small macular holes.
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Joondeph BC, Willems P, Raber T, Duchateau L, Markoff J. Prognostic Factors Associated with Ocriplasmin Efficacy for the Treatment of Symptomatic Vitreomacular Adhesion and Full-thickness Macular Hole: Analysis from Four Studies. J Ophthalmic Vis Res 2021; 16:42-55. [PMID: 33520127 PMCID: PMC7841271 DOI: 10.18502/jovr.v16i1.8250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/23/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the effect of patient baseline characteristics on the efficacy of ocriplasmin treatment for symptomatic vitreomacular adhesion (VMA) with full-thickness macular hole (FTMH) from phase 3/4 studies. Methods Patients with symptomatic VMA and FTMH at baseline and receiving ocriplasmin treatment 125 μg were pooled from the MIVI-TRUST, OASIS, and ORBIT studies. Multivariable logistic regression analysis was used to evaluate whether patient baseline characteristics were predictors of having VMA resolution by Day 28 and FTMH closure by Month 6. Results Two hundred and seventy-four patients receiving ocriplasmin treatment were assessed. Overall, 22.6% (62/274) of the patients experienced both VMA resolution by Day 28 and non-surgical FTMH closure by Month 6. Patients with FTMH ≤250 µm at baseline had a significantly higher success rate compared to those with FTMH >400 µm (29.9% [41/137] vs 2.2% [1/48]; P = 0.009). In patients with VMA resolution by Day 28, both small FTMH size (P = 0.001) and FTMH width at RPE (P = 0.012) were significantly associated with a higher FTMH closure rate. Patients with VMA resolution had higher rates of FTMH closure. Previously identified baseline predictive factors, including age, lens status, or presence of epiretinal membrane (ERM) were not found to be predictive of both VMA release and FTMH closure. Conclusion The analysis revealed that FMTH ≤250 µm was the only factor predictive for achieving both pharmacological VMA resolution by Day 28 and nonsurgical FTMH closure by Month 6; neither lens status or presence of ERM, previously identified baseline characteristics favoring VMA resolution, showed statistically significant predictive power for both outcomes.
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Affiliation(s)
| | | | | | - Luc Duchateau
- Biometrics Research Group, Ghent University, Gent, Belgium
| | - Joseph Markoff
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Thomas Jefferson Medical College, Philadelphia, Pennsylvania, USA
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Steel DHW, Patton N, Stappler T, Karia N, Hoerauf H, Patel N, Wachtlin J, Raber T, Kozma-Wiebe P. OCRIPLASMIN FOR VITREOMACULAR TRACTION IN CLINICAL PRACTICE: The INJECT Study. Retina 2021; 41:266-276. [PMID: 32496343 PMCID: PMC7819525 DOI: 10.1097/iae.0000000000002862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Randomized clinical trials have demonstrated the safety and efficacy of ocriplasmin in patients with vitreomacular traction (VMT), including those with macular hole (MH). The INJECT study prospectively evaluated ocriplasmin in the setting of clinical practice. METHODS INJECT was a Phase 4, multicenter, prospective observational study. Patients were followed up for 12 months. Assessments included nonsurgical VMT resolution, nonsurgical MH closure, best-corrected visual acuity, occurrence of vitrectomy, and adverse events. RESULTS The efficacy population (N = 395) received an ocriplasmin injection and had optical coherence tomography-confirmed VMT at baseline. At Day 28, the rate of nonsurgical VMT resolution was 40.7% in the overall group, and the rate of nonsurgical MH closure was 36.0% in the VMT with MH group. At Month 12, the rate of ≥2-line best-corrected visual acuity gain (irrespective of vitrectomy) was 36.8% in the overall group and 59.6% in the VMT with MH group. The percentage of patients who underwent vitrectomy in the study eye was 29.1% in the overall group and 55.6% in the VMT with MH group. Photopsia (9.8%) and vitreous floaters (6.8%) were the most frequent adverse events. CONCLUSION The INJECT study showed that ocriplasmin is effective in a clinical setting in patients with VMT, with or without MH. No new safety signals were identified from this large and surgeon-selected patient group, although the significant limitations of the study design without an image reading center and scheduled study visit timings should be noted.
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Affiliation(s)
- David H. W. Steel
- Sunderland Eye Infirmary, Sunderland, United Kingdom; Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Niall Patton
- Manchester Royal Eye Hospital, Manchester, United Kingdom
| | - Theodor Stappler
- Fondation Asile des Aveugles, Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland
| | - Niral Karia
- Southend University Hospital, Westcliff-on-Sea, United Kingdom
| | - Hans Hoerauf
- Augenklinik der Universitätsmedizin Göttingen, Göttingen, Germany
| | - Nishal Patel
- Department of Ophthalmology, Kent and Canterbury Hospital, East Kent Hospitals University, Canterbury, United Kingdom
| | - Joachim Wachtlin
- Augenheilkunde, Sankt Gertrauden-Krankenhaus GmbH, Berlin, Germany; Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany; and
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THE EFFECT OF ELECTIVE CATARACT EXTRACTION BY PHACOEMULSIFICATION IN EYES WITH VITREOMACULAR TRACTION SYNDROME. Retina 2021; 41:75-81. [PMID: 32106158 DOI: 10.1097/iae.0000000000002785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effect of cataract extraction (CE) by phacoemulsification on the vitreomacular interface (VMI) of eyes with preexisting vitreomacular traction (VMT). METHODS Retrospective, observational case series. Patients with VMT who elected to proceed with CE, before any vitreoretinal intervention, were studied. Eyes with at least a 12-month follow-up period were included. The status of the vitreomacular adhesion at different time points was assessed using spectral-domain optical coherence tomography. The best-corrected visual acuity was recorded at different time points. Other macular and systemic comorbidities were documented. RESULTS Fifteen eyes from 15 phakic patients with symptomatic VMT were included. Six of them were male subjects. Seven patients had diabetes mellitus and two of them also had nonproliferative diabetic retinopathy. The preoperative macular comorbidities included macular hole in six eyes (Stage 1 in 3 eyes and Stage 2 or 3 in another 3 eyes), epiretinal membrane in five eyes, and cystoid macular edema in four eyes. After uncomplicated CE, the VMT was released in 5 eyes, whereas in 10 eyes, CE did not significantly change the status of the vitreomacular adhesion. Three of 3 eyes with preexisting full-thickness macular hole (Stage 2 or 3 macular hole) were found to have Stage 4 macular hole shortly after CE. In seven of seven patients with diabetes mellitus, the status of the vitreomacular interface did not change after CE. Eventually, 7 of 15 patients underwent additional pars plana vitrectomy. Compared with the baseline vision, and vision before other interventions, the visual acuity after CE improved in 5 patients, remained unchanged in 7 patients, and decreased in the 3 patients with Stage 2 or 3 macular hole. The mean preoperative and early postoperative visual acuity was 20/59 and 20/68, respectively (P > 0.05). CONCLUSION The effect of CE in phakic eyes with known VMT varies significantly. In the current case series, every eye with VMT and Stage 2 or 3 macular hole ended up with Stage 4 macular hole, although the VMT did not change significantly in the eyes of diabetic patients. Studies with larger sample size are needed to further elucidate the impact of elective CE on VMT.
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Baghban R, Farajnia S, Ghasemi Y, Hoseinpoor R, Safary A, Mortazavi M, Zarghami N. Mutational Analysis of Ocriplasmin to Reduce Proteolytic and Autolytic Activity in Pichia pastoris. Biol Proced Online 2020; 22:25. [PMID: 33308171 PMCID: PMC7734836 DOI: 10.1186/s12575-020-00138-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Ocriplasmin (Jetrea) is using for the treatment of symptomatic vitreomacular adhesion. This enzyme undergoes rapid inactivation and limited activity duration as a result of its autolytic nature after injection within the eye. Moreover, the proteolytic activity can cause photoreceptor damage, which may result in visual impairment in more serious cases. RESULTS The present research aimed to reduce the disadvantages of ocriplasmin using site-directed mutagenesis. To reduce the autolytic activity of ocriplasmin in the first variant, lysine 156 changed to glutamic acid and, in the second variant for the proteolytic activity reduction, alanine 59 mutated to threonine. The third variant contained both mutations. Expression of wild type and three mutant variants of ocriplasmin constructs were done in the Pichia pastoris expression system. The mutant variants were analyzed in silico and in vitro and compared to the wild type. The kinetic parameters of ocriplasmin variants showed both variants with K156E substitution were more resistant to autolytic degradation than wild-type. These variants also exhibited reduced Kcat and Vmax values. An increase in their Km values, leading to a decreased catalytic efficiency (the Kcat/Km ratio) of autolytic and mixed variants. Moreover, in the variant with A59T mutation, Kcat and Vmax values have reduced compared to wild type. The mix variants showed the most increase in Km value (almost 2-fold) as well as reduced enzymatic affinity to the substrate. Thus, the results indicated that combined mutations at the ocriplasmin sequence were more effective compared with single mutations. CONCLUSIONS The results indicated such variants represent valuable tools for the investigation of therapeutic strategies aiming at the non-surgical resolution of vitreomacular adhesion.
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Affiliation(s)
- Roghayyeh Baghban
- Medical Biotechnology Department, Faculty of Advanced Medical Science, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Biotechnology Research Center, Tabriz University of Medical Sciences, Daneshgah Ave, Tabriz, Iran
| | - Safar Farajnia
- Biotechnology Research Center, Tabriz University of Medical Sciences, Daneshgah Ave, Tabriz, Iran.
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Younes Ghasemi
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Reyhaneh Hoseinpoor
- Department of Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azam Safary
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojtaba Mortazavi
- Department of Biotechnology, Institute of Science and High Technology and Environmental Science, Graduate University of Advanced Technology, Kerman, Iran
| | - Nosratollah Zarghami
- Medical Biotechnology Department, Faculty of Advanced Medical Science, Tabriz University of Medical Sciences, Tabriz, Iran
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Seamone ME, Rubin U, Grewal PS, Greve M. Pneumatic Vitreolysis With Intravitreal Air for Focal Vitreomacular Traction. JOURNAL OF VITREORETINAL DISEASES 2020; 5:348-353. [PMID: 37007599 PMCID: PMC9976235 DOI: 10.1177/2474126420962649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To determine whether pneumatic vitreolysis with intravitreal air is effective for focal vitreomacular traction (VMT). Methods: We conducted a retrospective consecutive case series of 20 eyes from 19 individuals with focal VMT who underwent pneumatic vitreolysis with intravitreal air (January 2017 to November 2018). We analyzed patients via spectral-domain optical coherence tomography before intravitreal air injection and at 1 month. The primary outcome measure was release of VMT. Results: We observed release of VMT in 55% of individuals. An analysis limited to phakic eyes demonstrated release of VMT in 69%, and 65% developed improved best-corrected visual acuity. Individuals with persistent VMT and visual improvement had a significant reduction in angle of vitreoretinal insertion ( P < .01), area under VMT ( P < .05), and subfoveal cyst area ( P < .05). Conclusions: Intravitreal air is an effective treatment for focal VMT. In individuals with persistent VMT, visual-acuity improvement was associated with a reduction in overall VMT.
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Affiliation(s)
- Mark E. Seamone
- Department of Ophthalmology & Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Uriel Rubin
- Department of Ophthalmology & Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Parampal S. Grewal
- Department of Ophthalmology & Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Greve
- Department of Ophthalmology & Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
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Recurrent Vitreomacular Traction in a Patient Treated with Ocriplasmin: A Case Report. Ophthalmol Ther 2020; 10:187-192. [PMID: 33108639 PMCID: PMC7886937 DOI: 10.1007/s40123-020-00316-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/15/2020] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION To describe a case of recurrent vitreomacular traction and macular edema that appeared both before and after the intravitreal injection of ocriplasmin. CASE REPORT An 82-year-old monocular man presented with metamorphopsia and reduced vision of 1-week duration. The patient's general medical history was unremarkable. His ophthalmic history was significant for severe ocular trauma in the right eye in childhood that caused phthisis. The left eye had undergone uncomplicated phacoemulsification 3 months earlier and the 1-month postoperative best corrected visual acuity (BCVA) was logarithmic mean angle of resolution (logMAR) 0.0. There was no history of other ocular conditions. At presentation, BCVA was logMAR 0.2 and optical coherence tomography (OCT) revealed the presence of cystoid macular edema caused by vitreomacular traction (VMT). The patient was scheduled for intravitreal ocriplasmin injection. Prior to treatment, the vision improved spontaneously to logMAR 0.1, and no VMT could be detected with spectral domain (SD)-OCT. The ocriplasmin injection was deferred but 3 weeks later the patient presented again with metamorphopsia, while VMT was again evident on SD-OCT. Ocriplasmin was injected and 1 month later the BCVA reached logMAR 0.1 without VMT. However, at 2 months post injection the VMT reappeared and a conservative approach with observation and topical nepafenac administration was decided. At the 3-month post-injection visit there was no VMT. More than 3 years after the ocriplasmin injection there is still no evidence of VMT, the patient is free of metamorphopsia, and his BCVA is logMAR 0.0. CONCLUSION Separation of consecutive layers of the vitreous cortex (vitreoschisis) may account for recurrent VMT.
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ASSESSMENT OF ANATOMICAL AND FUNCTIONAL OUTCOMES WITH OCRIPLASMIN TREATMENT IN PATIENTS WITH VITREOMACULAR TRACTION WITH OR WITHOUT MACULAR HOLES: Results of OVIID-1 Trial. Retina 2020; 39:2341-2352. [PMID: 30308558 PMCID: PMC6889902 DOI: 10.1097/iae.0000000000002332] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Enzymatic vitreolysis with ocriplasmin is more effective in patients with focal vitreomacular adhesion without epiretinal membrane and macular hole ≤400 µm (if present) at baseline. This study shows that the treatment outcomes are related to patient selection. Purpose: To evaluate the anatomical and functional outcomes with ocriplasmin in patients with vitreomacular traction (VMT) with or without macular hole (MH). Methods: In a Phase 4, multicenter, single-arm, open-label study, eligible patients (VMT with focal adhesion, without epiretinal membrane, and with MH ≤400 µm [if present]) received a single intravitreal injection of ocriplasmin. Nonsurgical resolution of VMT (Day 28 [primary endpoint]), best-corrected visual acuity, MH closure, vitrectomy rate, and safety were assessed through Day 180. Results: Overall, 466 patients were included in the full analysis set, of whom 47.4% had VMT resolution by Day 28; resolution rates in patients with VMT without MH, VMT with MH ≤250 µm, and VMT with MH >250 to ≤400 µm were 43.4%, 68.6%, and 62.7%, respectively. Macular hole closure was higher in eyes with VMT and MH ≤250 µm (57.1%) than in eyes with VMT and MH >250 to ≤400 µm (27.5%) at Day 28. Overall, 30.8% of patients with VMT resolution gained ≥10 letters in best-corrected visual acuity at Day 180. Adverse events were consistent with the known safety profile of ocriplasmin. Conclusion: Ocriplasmin is effective for resolution of VMT without or with MH (≤400 μm); treatment outcomes can be optimized with patient selection.
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Yu BE, Sheidow T, Sambhi RDS, Hooper P, Malvankar-Mehta MS. The effectiveness of ocriplasmin versus surgery for the treatment of macular holes: A systematic review and meta-analysis. Eur J Ophthalmol 2020; 31:2003-2012. [PMID: 32731755 DOI: 10.1177/1120672120946925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To conduct a systematic review looking at the effects of ocriplasmin compared to pars plana vitrectomy on macular holes to assess the effectiveness of the treatment options. METHODS Literature was searched through MEDLINE, EMBASE, CINAHL, Clinical Trials.gov, and ProQuest Dissertations and Theses until June 12, 2018. Conferences held through Association for Research in Vision and Ophthalmology, Canadian Society of Ophthalmology, and American Academy of Ophthalmology were searched until June 18, 2018. A total of 208 records were screened leaving 26. One author independently reviewed them for quality and extracted data. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were followed. The adverse events, MH closure rate, change in MH size, and the extent to which the patients' visual acuity is restored by each treatment option; ocriplasmin and vitrectomy. RESULTS Twenty-six articles were included for qualitative and quantitative analysis. Meta-analysis results showed a 34% closure of macular holes after ocriplasmin treatment compared to 92% after vitrectomy. A significant improvement in visual acuity was seen after vitrectomy (SMD = -1.42; CI: [-1.98, -0.86]) as well as the ocriplasmin treatment (SMD = -0.73; CI: [-0.98, -0.48]). CONCLUSIONS Results suggested 92% macular hole closure after vitrectomy compared to 34% after ocriplasmin. A significant improvement in visual acuity of patients was seen after both treatments. More good quality randomized controlled trials are required to make strong conclusions.
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Affiliation(s)
- Brian Edward Yu
- Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Tom Sheidow
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Raman-Deep Singh Sambhi
- Schulich School of Medicine and Dentistry, The University of Western Ontario, Windsor, ON, Canada
| | - Phil Hooper
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Monali S Malvankar-Mehta
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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Goh LY, Motta L, Jackson TL. Myopic macular hole detachment associated with intravitreal ocriplasmin. Am J Ophthalmol Case Rep 2020; 19:100697. [PMID: 32637726 PMCID: PMC7327198 DOI: 10.1016/j.ajoc.2020.100697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/26/2020] [Accepted: 04/02/2020] [Indexed: 12/04/2022] Open
Abstract
Purpose To describe a case of macular hole retinal detachment in a high myope following intravitreal ocriplasmin injection. Observations A 71-year-old highly myopic (−18.63 Dioptres) female received 125 μg of intravitreal ocriplasmin (Jetrea, Oxurion, Leuven, Belgium) to treat a right, full-thickness macular hole (FTMH) with vitreomacular adhesion. Presenting best-corrected visual acuity (BCVA) letter score was 45, using the Early Treatment Diabetic Retinopathy Study chart. Past ocular history in the affected, pseudophakic eye included anisometropic amblyopia, but with a documented pre-morbid BCVA of 75 letters. One week post-injection the vitreomacular adhesion persisted. One month post-injection, a large posterior macular hole retinal detachment developed with BCVA of 45 letters. Over the course of one year she underwent three pars plana vitrectomies aiming to treat the retinal detachment and close the FTMH. The detachment was treated successfully but the FTMH persisted, albeit with a reduced diameter. Final BCVA was 55 letters. Conclusions The pathogenesis of this macular hole detachment may be related to the combination of a FTMH and high myopia. Ocriplasmin functions in a twofold manner; inducing a posterior vitreous detachment and as a proteolytic enzyme digesting the fibronectin and laminin at the pathological vitreoretinal interface. With access through a FTMH, ocriplasmin may exert an enzymatic effect on the interphotoreceptor matrix and the photoreceptor-retinal pigment epithelium interface that normally helps maintain neuroretinal adhesion to the retinal pigment epithelium. The reported increase in basal diameter of FTMHs following ocriplasmin supports this hypothesis. High myopia was another likely contributing factor. Highly myopic patients were excluded from the initial ocriplasmin registration studies, mainly due to the risk of retinal detachment, but were eligible for subsequent large trials. Importance Clinicians should be aware of a potential association between ocriplasmin and macular hole detachments in eyes with high myopia.
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Affiliation(s)
- Li Yen Goh
- Department of Ophthalmology, King's College Hospital, London, United Kingdom
| | - Lorenzo Motta
- Department of Ophthalmology, King's College Hospital, London, United Kingdom
| | - Timothy L. Jackson
- Department of Ophthalmology, King's College Hospital, London, United Kingdom
- Faculty of Life Science and Medicine, King's College London, London, United Kingdom
- Corresponding author. FRCOphth King's College London Department of Ophthalmology King's College Hospital, London, SE5 9RS, United Kingdom.
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Abstract
The MP-1 substudy of the OASIS trial evaluated the effects of ocriplasmin and symptomatic VMA resolution on visual fixation and macular sensitivity using microperimetry, identifying parameters that were distinct between patients with and without VMA resolution. Purpose: To evaluate the effects of ocriplasmin and symptomatic vitreomacular adhesion resolution on visual fixation and macular sensitivity using microperimetry. Methods: MP-1 parameters were analyzed from 3 OASIS sites after the use of standardized instruments and testing procedures over 24 months. Results: A total of 27 patients (19 ocriplasmin, 8 sham) were evaluated. Mean distance of the preferred fixation locus to the anatomical center was farther in the sham group at baseline and farther in the sham versus ocriplasmin group throughout the study. Retinal sensitivity values were consistently higher in the ocriplasmin versus sham group after Month 3. Fewer patients in the ocriplasmin group had predominantly eccentric fixation at study end compared with the sham group, which also had an increased number of patients with unstable fixation. Patients with vitreomacular adhesion resolution had lower bivariate contour area, fewer relative scotomas, and higher retinal sensitivity parameters at baseline than those with unresolved vitreomacular adhesion. Conclusion: Substudy results suggest that fixation and sensitivity parameters tended to be better in the ocriplasmin group than in the sham group over time. The substudy identified parameters that were distinct between patients with and without vitreomacular adhesion resolution, suggesting that microperimetry warrants further study as a relevant biomarker for visual function.
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Khanani AM, Dugel PU, Haller JA, Wagner AL, Lescrauwaet B, Schmidt R, Bennison C. Cost-effectiveness analysis of ocriplasmin versus watchful waiting for treatment of symptomatic vitreomacular adhesion in the US. J Comp Eff Res 2020; 9:287-305. [PMID: 31961196 DOI: 10.2217/cer-2019-0117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Evaluate the cost-effectiveness of ocriplasmin in symptomatic vitreomacular adhesion (VMA) with or without full-thickness macular hole ≤400 μm versus standard of care. Methods: A state-transition model simulated a cohort through disease health states; assignment of utilities to health states reflected the distribution of visual acuity. Efficacy of ocriplasmin was derived from logistic regression models using Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion Including Macular Hole trial data. Model inputs were extracted from Phase III trials and published literature. The analysis was conducted from a US Medicare perspective. Results: Lifetime incremental cost-effectiveness ratio was US$4887 per quality-adjusted life year gained in the total population, US$4255 and US$10,167 in VMA subgroups without and with full-thickness macular hole, respectively. Conclusion: Ocriplasmin was cost effective compared with standard of care in symptomatic VMA.
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Affiliation(s)
- Arshad M Khanani
- Sierra Eye Associates, Reno, NV 89502, USA.,Reno School of Medicine, University of Nevada, Reno, NV 89557, USA
| | - Pravin U Dugel
- Retina Consultants of Arizona, Phoenix, AZ 85053, USA.,USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Julia A Haller
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Alan L Wagner
- Wagner Macula & Retina Center, Virginia Beach, VA 23454, USA.,Department of Ophthalmology, Eastern Virginia Medical School, Virginia Beach, VA 23456, USA
| | | | - Ralph Schmidt
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, The Netherlands (Pharmerit International, Berlin, Germany at the time of project development & analysis)
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Hung JH, Horng YH, Chu HC, Li MS, Sheu SJ. Tailored internal limiting membrane flap technique for primary macular hole. Graefes Arch Clin Exp Ophthalmol 2020; 258:759-766. [PMID: 31900649 DOI: 10.1007/s00417-019-04596-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate the outcomes of primary full-thickness macular hole (MH) after surgical intervention with tailored internal limiting membrane (ILM) flap technique. METHODS Patients were reviewed for their clinical characteristics and surgical outcomes. The technique included incomplete circular peeling of the perifoveal ILM which was then trimmed according to the size of the MH. Fluid-gas exchange was done without further manipulation. RESULTS Nineteen eyes of 19 patients were included. The patients were in average 61 years old (range 41-83) and had an average follow-up period of 11.0 months. At baseline visit, minimal linear diameter of the MH was 311.6 μm (range 80-768). After a single surgery, the MH closed in all cases with improvement of mean visual acuity (from 0.9 to 0.4 logarithm of the minimum angle of resolution units, p < 0.0001, Wilcoxon signed-rank test). At the final visit, 15 (78.9%) eyes achieved a visual acuity ≥ 20/40. Outer retinal gliosis was found to be associated with less favorable postoperative visual acuity. Factors related to the formation of outer retinal gliosis were worse preoperative visual acuity and a large MH with a diameter > 400 μm. CONCLUSION Tailored ILM flap technique is an effective method for favorable anatomical and visual outcomes for treatment of primary MH.
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Affiliation(s)
- Jia-Horung Hung
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Ophthalmology National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Harn Horng
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hui-Chen Chu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Syuan Li
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. .,Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. .,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Ophthalmology, Kaohsiung Medical University, No.100, Tzyou 1st Rd. Sanmin Dist., 80756, Kaohsiung City, Taiwan.
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Bormann C, Apitzsch BC, Habermann A, Hammer U, Hammer T. EXPERIENCE WITH OCRIPLASMIN IN PATIENTS WITH VITREOMACULAR TRACTION SYNDROME: A RETROSPECTIVE STUDY OF 10 PATIENTS. Retin Cases Brief Rep 2020; 14:377-380. [PMID: 29621042 DOI: 10.1097/icb.0000000000000717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To assess the efficacy of ocriplasmin in patients with vitreomacular traction (VMT) syndrome <1,500 μm with or without a full-thickness macular holes of <400 μm. METHODS In this study, a retrospective analysis of 10 eyes of 10 patients with VMT who were treated with ocriplasmin between December 2014 and January 2016 was performed. Ocriplasmin 0.125 mg was injected only once in all cases. Outcome measures included the detachment of VMT, best-corrected visual acuity, the evaluation of optical coherence tomography, including the closure of full-thickness macular holes, and the reduction of macular edema (if present) and the decrease of metamorphopsia if present. RESULTS Ten patients (7 women and 3 men) with an average age of 75.1 years (range, 63-84 years) were treated with ocriplasmin with a follow-up period of 8 weeks. All patients were treated for VMT syndrome, and 5 patients (50.0%) showed an additional macular hole. An absolute detachment of VMT was seen in 3 patients (30.0%) and partially in 4 patients (40.0%). In three of the five patients, a complete closure of the full-thickness macular holes was seen. The two other patients needed an additional pars plana vitrectomy as a result of the persistent macular hole. An improvement of visual acuity was seen in 6 out of 10 patients (60.0%), a reduction of macular edema in 8 out of 9 patients (88.9%), and a decrease of metamorphopsia in 6 out of 7 patients (85.7%). CONCLUSION In this retrospective analysis, the treatment with ocriplasmin showed a resolution of VMT in 7 of 10 patients (70.0%) after a follow-up period of 8 weeks.
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Affiliation(s)
| | | | | | - Ute Hammer
- Eye Center "Frohe Zukunft," Halle (Saale), Germany
| | - Thomas Hammer
- Eye Center "Frohe Zukunft," Halle (Saale), Germany
- University Eye Hospital, Halle (Saale), Germany
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Abstract
PURPOSE To compare the effect of intravitreal injections of air with gas on vitreomacular traction (VMT) release and attempt to analyze predictive factors for success. METHODS The medical records of patients with symptomatic VMT undergoing intravitreal injections (0.3 mL) of either octafluoropropane (C3F8) or air were retrospectively reviewed. The VMT release (primary end point) and the best-corrected visual acuity (secondary end point) were noted 1 month after injection. At baseline and 1 month after the injection, a macular optical coherence tomography was performed. RESULTS Twenty-four eyes of 22 patients were included. Vitreomacular traction was released in 10 cases, 7 among 11 C3F8-injected eyes (63%) and 3 among 13 air-injected eyes (23%) (P = 0.045). In eyes with released VMT, ETDRS improved from 61 ± 35 (0-100) to 65 ± 37 (0-100) 1 month after the injection (P = 0.03). All patients with VMT release had a horizontal vitreomacular adhesion of less than 600 µm. Five eyes (23%) underwent vitrectomy after the injection of gas or air. CONCLUSION Posterior vitreous detachment in VMT can be observed with both air and gas injection with a low complication rate. The occurrence of VMT release observed with air seemed to be less frequent than that observed with gas.
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Anderson MF, Magal I, Ells A, Fielden M, Mahsin M, Kherani A, Williams RG. Intravitreal gas injection for the treatment of full-thickness macular holes. Can J Ophthalmol 2019; 55:e13-e18. [PMID: 31712036 DOI: 10.1016/j.jcjo.2019.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/23/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Affiliation(s)
| | | | - Anna Ells
- University of Calgary, Calgary, Alberta
| | | | - Md Mahsin
- University of Calgary, Calgary, Alberta
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45
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Idiopathic Macular Hole Preferred Practice Pattern®. Ophthalmology 2019; 127:P184-P222. [PMID: 31757499 DOI: 10.1016/j.ophtha.2019.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 11/21/2022] Open
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Tosi GM, Bacci T, Tarantello A, Marigliani D, Calmanti G, Polito MS, Neri G, Fusco F, Cevenini G, Virgili G. Vitreomacular interface alterations following peripheral laser retinopexy: Interface changes after laser. Eur J Ophthalmol 2019; 30:941-947. [PMID: 31538489 DOI: 10.1177/1120672119876547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To demonstrate the morphological outcomes of macular hole following prophylactic peripheral laser retinopexy (PPLR). METHODS Our retrospective case-control analysis included 92 eyes, 55 in the laser group and 37 in the non-laser group. Fifty-five patients were subjected to prophylactic peripheral laser retinopexy in preparation for pars plana vitrectomy for macular hole, with and without vitreomacular adhesion (laser group). Before and after prophylactic peripheral laser retinopexy, we evaluated any changes in vitreomacular anatomy by optical coherence tomography. Optical coherence tomography changes were also analyzed in the visits preceding pars plana vitrectomy in 37 macular hole eyes not subjected to prophylactic peripheral laser retinopexy (non-laser group). RESULTS In the laser group, 7 out of 55 eyes (12.7%) showed macular hole closure (6 out of 18 macular hole eyes with vitreomacular adhesion (33.3%) and 1 out of 37 eyes without vitreomacular adhesion (2.7%)), while no patients showed macular hole closure in the non-laser group (p < 0.05). The mean width of the seven closed macular hole was 191.4 µm (range: 59-282 µm). In all except one of the six macular hole eyes with vitreomacular adhesion, the macular hole closed without vitreomacular adhesion release. In our analysis of the patient subgroup with vitreomacular adhesion, we observed a release of vitreomacular adhesion in 3 out of 18 eyes (16.6%) in the laser group and in 1 out of 13 eyes (7.6%) in the non-laser group (p > 0.05). CONCLUSION These findings support a possible beneficial role for prophylactic peripheral laser retinopexy in selected individuals with macular hole.
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Affiliation(s)
- Gian Marco Tosi
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - Tommaso Bacci
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - Antonio Tarantello
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - Davide Marigliani
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - Giacomo Calmanti
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - Maria Sole Polito
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - Giovanni Neri
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - Fiorella Fusco
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - Gabriele Cevenini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Gianni Virgili
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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Özdemir HB, Özdek Ş, Hasanreisoğlu M. Pneumatic Vitreolysis for the Treatment of Vitreomacular Traction Syndrome. Turk J Ophthalmol 2019; 49:201-208. [PMID: 31486607 PMCID: PMC6761384 DOI: 10.4274/tjo.galenos.2019.00400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: To evaluate the posterior vitreous release rates after a single injection of expansile gas in patients with vitreomacular traction (VMT) syndrome with or without associated full-thickness macular hole (FTMH). Materials and Methods: Thirteen eyes of 12 consecutive patients with VMT (11 eyes) or VMT+FTMH (2 eyes) were reviewed retrospectively. Intravitreal injection of 0.3 mL of pure sulfur hexafluoride (SF6) (9 eyes) or perfluoropropane (C3F8) (4 eyes) was performed. Bobbing the head forward and backward similar to ‘drinking bird’ head movements was instructed until VMT release. Full ophthalmic examination and optical coherence tomography was performed at each visit. Results: VMT was released in all patients (100%) and mean release time was 5.2 days (1-19 days). Macular hole closure was not achieved in either of the two eyes with FTMH. Mean central subfield thickness decreased significantly from 361 μm to 263 μm (p=0.007). The mean pretreatment visual acuity was 0.44 LogMAR, which significantly improved to 0.25 LogMAR at the last visit (p=0.003). One of 13 eyes had retinal tear after the procedure which was successfully treated with laser retinopexy. Gas migration to the anterior chamber occurred in one patient. No other complications were observed. Conclusion: Pneumatic vitreolysis with C3F8 and SF6 gases is a relatively safe, low-cost, and minimally invasive treatment modality for VMT. However, FTMH closure could not be achieved with pneumatic vitreolysis.
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Affiliation(s)
- Hüseyin Baran Özdemir
- University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey
| | - Şengül Özdek
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Murat Hasanreisoğlu
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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Alpay A. Posterior vitreous detachment rate following intravitreal dexamethasone injection. Int J Ophthalmol 2019; 12:1298-1303. [PMID: 31456920 DOI: 10.18240/ijo.2019.08.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 03/12/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To determine whether intravitreal dexamethasone (DEX) implant induces posterior vitreous detachment or not. METHODS We retrospectively reviewed 810 eyes of 405 patients who underwent intravitreal DEX implantation due to macular edema caused by diabetic and retinal venous occlusion in our clinic. The eyes having no injection were determined as the control group. The examination findings of the patients before the injection and 3mo after the injection and optical coherence tomography (OCT) images were scanned. The pre-injection OCT findings and OCT findings of the patients having no posterior vitreous detachment (PVD) and determined to have partial PVD were compared. RESULTS The separation in vitreoretinal adhesion and total PVD development of DEX-injected 56/208 (26.9%) eyes were statistically greater in comparison with the 12/129 (9.3%) eyes that had not been injected (P=0.001). PVD development was observed more in the patients that were younger, had larger macula thickness and lower visual acuity. CONCLUSION It can be stated that intravitreal DEX implant induces PVD development. Prospective, controlled studies are required in order to determine prognosis of vitreoretinal disease in PVD-developed patients and in non-PVD-developed patients.
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Affiliation(s)
- Atilla Alpay
- Department of Ophthalmology, the School of Medicine, Zonguldak Bülent Ecevit University, Zonguldak 67600, Turkey
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Schatz A, Seuthe A, Januschowski K. Effect of Ocriplasmin on objectively assessed retinal function after treatment of vitreomacular diseases. Acta Ophthalmol 2019; 97:e700-e705. [PMID: 30730114 DOI: 10.1111/aos.14030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 12/15/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The scope of the study was the functional assessment of possible effects of intravitreally injected ocriplasmin using electroretinographical (ERG) examinations. METHODS Seven subjects suffered from pathologies within the label of ocriplasmin (Jetrea® ) were examined in the study. An extended international society for clinical electrophysiology of vision ERG protocol was used for baseline recordings (before treatment) and was repeated for comparison 3 months after treatment with intravitreally injected ocriplasmin. All subjects were examined using 6 steps and a 9 Hz flicker protocol as scotopic flicker response under dark-adapted conditions. Under light-adapted conditions, two single-flash responses (standard flash and On/Off protocol) and a 31 Hz flicker response was used for functional assessment. RESULTS A significant reduction of amplitudes was found for the lowest stimulation intensity (0.0001 cd.s/m²) under dark-adapted conditions after treatment (p = 0.027). All other parameters were not significantly different after treatment including the scotopic flicker response. Under light-adapted state, the a- and b-wave amplitudes were not significantly altered after treatment for single-flash and flicker responses. The On- and Off-responses were not significantly different between baseline and after the treatment. CONCLUSIONS One single significant difference of all examined parameters mirrors a difference due to chance, even if a negative effect of proteolytic enzymes on laminin and fibronectin of retinal cells cannot be entirely excluded. Nevertheless, this result should be respected in order to ensure a safe use of ocriplasmin for patients with vitreoretinal disorders.
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Affiliation(s)
- Andreas Schatz
- Department of Ophthalmology Katharinenhospital Klinikum Stuttgart Stuttgart Germany
- Centre for Ophthalmology University of Tübingen Tübingen Germany
| | | | - Kai Januschowski
- Centre for Ophthalmology University of Tübingen Tübingen Germany
- Eye Clinic Sulzbach Knappschaft Hospital Saar Sulzbach Germany
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Lavine JA, Srivastava SK, Dukles N, Reese JL, Ehlers JP. Longitudinal ellipsoid zone and subretinal fluid mapping following ocriplasmin injection in the prospective observational ORBIT trial. Br J Ophthalmol 2019; 104:410-415. [PMID: 31248879 DOI: 10.1136/bjophthalmol-2019-314142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/30/2019] [Accepted: 05/08/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Ocriplasmin is approved for the treatment of symptomatic vitreomacular traction (VMT). However, several retrospective reports have identified ellipsoid zone (EZ) alterations on spectral domain optical coherence tomography (SDOCT) after ocriplasmin injection. This report quantitatively analysed outer retinal changes after intravitreal ocriplasmin. METHODS Ocriplasmin Research to Better Inform Treatment is a prospective, observational phase IV clinical study where subjects received a single intravitreal injection of ocriplasmin for symptomatic VMT. Macular cube scans were imported into a semiautomated EZ mapping and fluid feature extraction software for SDOCT analysis. Change in visual acuity, VMT release, macular hole (MH) closure, EZ integrity/volume and subretinal fluid (SRF) volume on SDOCT macular cube scans were recorded and analysed. RESULTS This analysis included 55 participants with 6 months of follow-up. Intravitreal ocriplasmin injection caused VMT release in 67% and MH closure in 82% of participants. Visual acuity improved by 4.5 letters (p<0.05) in the whole cohort and by 6.0 letters (p<0.05) in participants with VMT release. EZ volume was reduced by 23.4% at week 1 (p<0.001) and recovered to baseline by between months 3 and 6. EZ volume loss at week 1 did not correlate with ETDRS acuity at final visit. CONCLUSION Ocriplasmin treatment resulted in VMT release, MH closure and visual acuity gains in a significant portion of eyes. EZ volume was significantly reduced at week 1, but recovered to baseline levels by final follow-up and was not associated with final visual acuity.
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Affiliation(s)
- Jeremy A Lavine
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States.,Department of Ophthalmology, Northwestern University, Chicago, Illinois, United States
| | - Sunil K Srivastava
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States.,The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH, United States
| | - Neeley Dukles
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States.,The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH, United States
| | - Jamie L Reese
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States.,The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH, United States
| | - Justis P Ehlers
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States .,The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH, United States
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