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Liu J, Wang H, Gu W, Zhao T, Fan W, Peng S. Safety of YAG laser vitreolysis for intraocular tissues: analysis of postoperative complications. Int Ophthalmol 2023; 43:4585-4593. [PMID: 37665493 PMCID: PMC10724304 DOI: 10.1007/s10792-023-02858-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 08/20/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE To evaluate the safety of yttrium-aluminum-garnet (YAG) laser vitreolysis for intraocular tissues. METHODS Thirty-six New Zealand rabbits were divided as follows: Group 1000 (n = 12) treated with YAG laser of 1000 mJ (5 mJ × 200 shots), Group 2000 (n = 12) treated with YAG laser of 2000 mJ (5 mJ × 400 shots), Group 3000 (n = 12) treated with YAG laser of 3000 mJ (5 mJ × 600 shots). Either a single eye was chosen as the study eye in study groups while the other was untreated as the control group. Intraocular pressure (IOP), slit-lamp, optical coherence tomography (OCT), transmission electron microscopy (TEM), and inflammatory cytokines of aqueous humor (interleukin-1α (IL-1α), interleukin-1β (IL-1β), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α)) were performed to examine the rabbits. RESULTS There were no abnormalities in the study groups of IOP, slit-lamp, and OCT examinations. Group 3000 of TEM showed: neutrophils and mitochondrial swelling on day 1, and fibroblasts and neocollagen on day 14. No abnormalities were observed in Group 1000 and 2000 of TEM. Levels of IL-1α and TNF-α increased at 12 h and decreased to baseline on day 3. Levels of IL-1β increased at 12 h and decreased to baseline on day 7. Levels of IL-8 increased on day 1 and decreased to baseline on day 3. CONCLUSION YAG laser vitreolysis is safe when the distance is more than 2 mm from ablation point to the lens and the retina, and the total energy is less than 2000 mJ for one treatment procedure.
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Affiliation(s)
- Jiannan Liu
- Department of Ophthalmology, Dongguan Aier Eye Hospital Affiliated to Jinan University, Dongguan, Guangdong, China
| | - Hao Wang
- Department of Ophthalmology, Hebei Eye Hospital, Xingtai, Hebei, China
| | - Wei Gu
- Department of Ophthalmology, Beijing Aier-Intech Eye Hospital, Beijing, China
| | - Tingting Zhao
- Department of Ophthalmology, Harbin Aier Eye Hospital, Harbin, Heilongjiang, China
| | - Wenxue Fan
- Department of Ophthalmology, Harbin Aier Eye Hospital, Harbin, Heilongjiang, China
| | - Shaomin Peng
- Aier School of Ophthalmology, Central South University, No. 188 Furongnan Road, Changsha, Hunan, China.
- Department of Ophthalmology, Harbin Aier Eye Hospital, Harbin, Heilongjiang, China.
- Aier Retina Institute, Changsha, Hunan, China.
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Zandi S, Freiberg F, Vaclavik V, Pfister IB, Traine PG, Kaya C, Michels S, Garweg JG. Morphological Reconstitution and Persistent Changes After Intravitreal Ocriplasmin for Vitreomacular Traction and Macular Hole. J Ocul Pharmacol Ther 2020; 36:126-132. [PMID: 31934816 DOI: 10.1089/jop.2019.0051] [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: 11/13/2022] Open
Abstract
Purpose: To assess the long-term anatomical and functional findings in patients with symptomatic vitreomacular traction (VMT), with or without full thickness macular hole (FTMH), after eye treatment with intravitreal ocriplasmin injection (IOI). Methods: This longitudinal case series includes 51 eyes from 51 symptomatic patients with VMT (<800 μm) who received a single IOI (Jetrea® 0.125 mg); 21 cases with an FTMH (<400 μm) were included. Best-corrected visual acuity (BCVA) and optical coherence tomography findings were recorded before IOI, and 1 day to 24 months thereafter. Data are presented as mean ± standard deviation. Results: Mean adhesion size before injection was 345 ± 146 μm. In 34 eyes (67%), complete release of VMT was observed; whereas VMT persisted in 17 eyes (33%). The latter included 15 of the 21 eyes (71%) with FTMH, 15 of which underwent pars plana vitrectomy and inner limiting membrane peeling. BCVA improved from (logarithm of the minimal angle of resolution [logMAR]) 0.41 ± 0.03 before injection to 0.32 ± 0.03 after 1 month and 0.23 ± 0.05 after 6 months and remained stable thereafter (0.24 ± 0.06 after 24 months of follow-up). Forty-five percent of the eyes presented submacular deposits soon after IOI that were not functionally relevant; 61% completely resolved by 12 months. Except floaters that disappeared within 48 h, no other adverse events were reported during follow-up. Conclusions: Treatment with ocriplasmin in a real-life setting showed an overall efficacy of 67% in patients with symptomatic VMT, with better results evident in the absence of an FTMH (70% vs. 62% VMT release) and a visual gain for over 2 years.
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Affiliation(s)
- Souska Zandi
- Swiss Eye Institute, Berner Augenklinik am Lindenhofspital, Bern, Switzerland.,Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Veronika Vaclavik
- HFR Kantonsspital, Freiburg, Switzerland.,Department of Ophthalmology, Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland
| | - Isabel B Pfister
- Swiss Eye Institute, Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| | - Peter G Traine
- Swiss Eye Institute, Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| | - Cagdas Kaya
- Swiss Eye Institute, Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| | - Stephan Michels
- Eye Clinic Zurich West, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Justus G Garweg
- Swiss Eye Institute, Berner Augenklinik am Lindenhofspital, Bern, Switzerland.,Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Shaikh M, Miller JB, Papakostas TD, Husain D. The Efficacy and Safety Profile of Ocriplasmin in Vitreomacular Interface Disorders. Semin Ophthalmol 2016; 32:52-55. [PMID: 27786583 DOI: 10.1080/08820538.2016.1228416] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Vitreomacular adhesion (VMA) describes the adhesion of the posterior hyaloid face to the inner retina in any part of the macula. This can arise after incomplete separation of the posterior vitreous cortex from the macula during vitreous liquefaction. While the VMA may resolve spontaneously, a strong and persistent adhesion can lead to a variety of anatomical changes, including vitreomacular traction (VMT) and macular hole (MH). Both conditions can present with metamorphopsia and decreased vision. In cases of symptomatic VMT and full-thickness macular hole, pars plana vitrectomy has long been the standard of care. However, due to the possible surgical complications and need for postoperative care, many have searched for non-surgical options via pharmacologic vitreolysis. Ocriplasmin (Jetrea, Thrombogenics USA, Alcon/Novartis EU) is a recombinant protease approved in October 2012 for the treatment of symptomatic vitreomacular adhesion (VMA). There have been conflicting views on the safety of Ocriplasmin with changes in the ellipsoid zone seen on OCT and changes seen on ERG indicating photoreceptor damage. This publication reviews the efficacy and safety of ocriplasmin injection for VMA based on previously published data.
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Affiliation(s)
- Mehrine Shaikh
- a Department of Ophthalmology , Harvard Medical School, Retina Service, Massachusetts Eye and Ear Infirmary , Boston , MA , USA
| | - John B Miller
- a Department of Ophthalmology , Harvard Medical School, Retina Service, Massachusetts Eye and Ear Infirmary , Boston , MA , USA
| | - Thanos D Papakostas
- a Department of Ophthalmology , Harvard Medical School, Retina Service, Massachusetts Eye and Ear Infirmary , Boston , MA , USA
| | - Deeba Husain
- a Department of Ophthalmology , Harvard Medical School, Retina Service, Massachusetts Eye and Ear Infirmary , Boston , MA , USA
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Lee YS, Wang NK, Chen YP, Chen KJ, Hwang YS, Lai CC, Wu WC. Plasmin Enzyme-Assisted Vitrectomy in Pediatric Patients with Vitreoretinal Diseases. Ophthalmic Res 2016; 56:193-201. [PMID: 27497808 DOI: 10.1159/000447406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/04/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of using plasmin-assisted vitrectomy in pediatric patients with vitreoretinal diseases. METHODS We prospectively recruited children aged 16 years or younger who presented with vitreoretinopathies and underwent plasmin-assisted vitrectomy between 2012 and 2013. The main outcome measure was the induction of posterior vitreous detachment (PVD) using a suction power of 200 mm Hg or less during surgery. RESULTS Eleven eyes of 11 patients (mean age: 3.7 years; average follow-up duration: 14.1 months) were included. Of these 11 patients, there were 3 (27%) cases of stage 5 retinopathy of prematurity, 2 (18%) cases of persistent fetal vasculature, 2 (18%) cases of rhegmatogenous retinal detachment, 2 (18%) cases of idiopathic epiretinal membrane, 1 (9%) case of traumatic macular pucker, and 1 (9%) case of traumatic vitreous hemorrhage (9%). PVD was achieved in all cases (100%) during surgery using low suction after plasmin treatment (mean: 150 ± 39 mm Hg; range: 100-200). Overall, anatomical success was achieved in 8 eyes (73%). Visual acuity improved in all 5 (100%) patients for whom vision could be measured at 6 months after the operation. Cataracts were found in 4 eyes (36%), and a rise in transient intraocular pressure was observed in 1 eye (9%). CONCLUSIONS Plasmin-assisted vitrectomy offers an effective and less traumatic intervention for a variety of pediatric vitreoretinal diseases.
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Affiliation(s)
- Yung-Sung Lee
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan, ROC
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5
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Madi HA, Haynes RJ, Depla D, de la Cour MD, Lesnik-Oberstein S, Muqit MMK, Patton N, Price N, Steel DHW. Rhegmatogenous retinal detachment following intravitreal ocriplasmin. Graefes Arch Clin Exp Ophthalmol 2016; 254:2333-2338. [PMID: 27278373 PMCID: PMC5116307 DOI: 10.1007/s00417-016-3398-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/03/2016] [Accepted: 05/24/2016] [Indexed: 11/12/2022] Open
Abstract
Purpose To describe the characteristics and outcomes of patients presenting with rhegmatogenous retinal detachment (RRD) after ocriplasmin (OCP) injection. Methods Retrospective, multi-centre, observational case series with case note review. Results Eight patients with symptomatic vitreomacular traction (six with concomitant macular hole) were diagnosed with RRD after a median of 16 days (range 3–131 days) post-OCP injection. Presentation was within 3 weeks of the OCP injection in six of the cases. Five patients presented with symptoms post-OCP, and three were diagnosed asymptomatically on planned visits. Seven cases were phakic, one had high myopia (>8 dioptres), and two cases had lattice degeneration. Following RRD surgery, hole closure was achieved in 5/6 MH cases. The final median BCVA at 7 months was 20/80 (range 20/40–20/1200) similar to the baseline BCVA 20/80, with four patients gaining ≥1 line of vision compared to baseline but three losing ≥3 lines. Conclusions RRD is a non-negligible risk associated with intravitreal OCP, and it should be used with caution in eyes with high myopia and peripheral retinal pathology predisposing to RRD. Detailed peripheral retinal examination is recommended pre- and postoperatively at all visits. Patients should be advised to seek attention if symptoms recur after initial presentation.
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Affiliation(s)
- Haifa A Madi
- Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, SR2 9HP, UK
| | | | - Diana Depla
- Ophthalmology Department, Cumberland Infirmary, Carlisle, UK
| | - Morten D de la Cour
- Eye Department, Rigshospitalet, Glostrup, Ndr. Ringvej 57, 2600, Glostrup, Denmark
| | - Sarit Lesnik-Oberstein
- Department of Ophthalmology, Academic Medical Centre, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands
| | - Mahi M K Muqit
- Vitreoretinal Service, Moorfields Eye Hospital, City Road, London, UK
| | - Niall Patton
- Manchester Royal Eye Hospital, Oxford Road, Manchester, UK
| | - Nick Price
- Royal Wolverhampton NHS Trust, Wolverhampton & Midland Counties Eye Infirmary, Wolverhampton, UK
| | - David H W Steel
- Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, SR2 9HP, UK. .,Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK.
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Chuang CC, Chen SN. Induction of Posterior Vitreous Detachment in Pediatric Vitrectomy by Preoperative Intravitreal Injection of Tissue Plasminogen Activator. J Pediatr Ophthalmol Strabismus 2016; 53:113-8. [PMID: 27018884 DOI: 10.3928/01913913-20160209-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 01/01/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the efficacy of intravitreal injection of tissue plasminogen activator (tPA) with or without autoserum in induction of posterior vitreous detachment (PVD) in pediatric vitrectomy. METHODS Retrospective, interventional case series of pediatric patients receiving intravitreal injection of tPA preoperatively to facilitate PVD in vitrectomy from January 2011 to December 2014 at the Changhua Christian Hospital, Taiwan. All patients received intravitreal injections of 25 µg of tPA 3 days before vitrectomy. For cases without preexisting vitreous hemorrhage, 0.1 mL of intravitreal autologous serum was co-administered. Main outcome measures included successful rate of posterior vitreous detachment in vitrectomy, visual outcome, and related ocular complications. RESULTS Four boys and 2 girls were included. Ages ranged from 39 weeks' postmenstrual age to 8 years. The indications for vitrectomy were traumatic macular hole (cases 1 and 2); premacular hemorrhage secondary to retinopathy of prematurity (case 3); abusive head trauma with premacular hemorrhage, subinternal limiting membrane hemorrhage, and macular hole (case 4); trauma with dense vitreous hemorrhage (case 5); and vitreous hemorrhage with unknown cause (case 6). Successful PVD was induced intraoperatively in all cases and the macular hole was closed successfully in 3 of 3 cases (cases 1, 2, and 4). No surgical complications were noted. Visual outcome improved in all 3 eyes with checkable preoperative visual acuity (cases 1, 2, and 6). CONCLUSIONS Intravitreal injection of tPA 3 days before vitrectomy may be a helpful adjunct to induce pediatric PVD.
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Soliman MK, Agarwal A, Sarwar S, Hanout M, Sadiq MA, Do DV, Nguyen QD. Pharmacologic Vitreolysis in Vascular Diseases of the Retina. Ophthalmic Surg Lasers Imaging Retina 2016; 47:60-8. [PMID: 26731211 DOI: 10.3928/23258160-20151214-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 10/22/2015] [Indexed: 11/20/2022]
Abstract
Vascular diseases of the retina such as diabetic retinopathy and vascular occlusions account for a large proportion of visual morbidity and blindness worldwide. The role of vitreous in the pathogenesis of these conditions has been increasingly recognized. Despite advances in the surgical technique of pars plana vitrectomy, the use of intravitreal agents for the lysis of vitreous has received attention, guided largely by promising results from the trials involving patients with non-vascular retinal diseases such as vitreomacular traction. The purpose of this review is to provide a comprehensive summary of the present knowledge on pathophysiologic basis of pharmacologic vitreolysis and its efficacy in vascular diseases of the retina. A review of completed and ongoing clinical trials will be presented, along with insights into future directions of this therapy.
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Association between anatomical resolution and functional outcomes in the mivi-trust studies using ocriplasmin to treat symptomatic vitreomacular adhesion/vitreomacular traction, including when associated with macular hole. Retina 2015; 35:1151-7. [PMID: 25741816 DOI: 10.1097/iae.0000000000000508] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate visual function in patients with symptomatic vitreomacular adhesion (VMA)/vitreomacular traction including when associated with macular hole after ocriplasmin treatment, and the association between resolution of the underlying condition and improvement in visual function. METHODS Six hundred and fifty-two patients from 2 Phase 3 trials received a single intravitreal injection of ocriplasmin 125 μg (n = 464) or placebo (n = 188). Mean and categorical changes from baseline in best-corrected visual acuity and 25-item Visual Function Questionnaire scores were used to evaluate visual function. Subgroups with VMA resolution and full-thickness macular hole closure were compared. RESULTS Overall, 42% of patients who achieved VMA resolution at Day 28 had a ≥2-line improvement in best-corrected visual acuity at Month 6, and 20% had a ≥3-line improvement. Likewise, 69% of patients with nonsurgical full-thickness macular hole closure at Day 28 had a ≥2-line improvement at Month 6, and 48% had a ≥3-line best-corrected visual acuity improvement. Mean improvements in 25-item Visual Function Questionnaire scores were associated with achieving VMA resolution and nonsurgical full-thickness macular hole closure. CONCLUSION In patients with symptomatic VMA/vitreomacular traction, VMA resolution and nonsurgical full-thickness macular hole closure were each associated with improvements in visual function. Resolving the underlying anatomical condition in symptomatic VMA/vitreomacular traction will increase the probability of achieving a clinically meaningful improvement in visual function.
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9
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Miller JB, Kim LA, Wu DM, Vavvas DG, Eliott D, Husain D. Ocriplasmin for treatment of stage 2 macular holes: early clinical results. Ophthalmic Surg Lasers Imaging Retina 2015; 45:293-7. [PMID: 25037011 DOI: 10.3928/23258160-20140709-05] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/25/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE To review clinical and structural outcomes of ocriplasmin for treatment of stage 2 macular holes. PATIENTS AND METHODS A retrospective review of the first patients with stage 2 macular holes to be treated with ocriplasmin at Massachusetts Eye and Ear Infirmary. All patients were imaged with spectral-domain optical coherence tomography (SD-OCT). RESULTS Eight patients with stage 2 macular holes received a single injection of 125 μg of ocriplasmin. One patient (12.5%) demonstrated macular hole closure. The posterior hyaloid separated from the macula in six eyes (75%). All seven holes that remained open showed enlargement in hole diameters (narrowest, apical, and basal) at 1 week and 1 month. All seven were successfully closed with surgery. Ellipsoid zone disruptions were observed by OCT in four eyes (50%) and persisted throughout follow-up (more than 6 months on average). CONCLUSION In early clinical results, the authors found a lower macular hole closure rate with ocriplasmin than previously reported. Enlargement was observed in all holes that failed to close with ocriplasmin. The authors found ellipsoid zone disruptions that persisted through 6 months of follow-up after ocriplasmin injection. Further work is needed to investigate the cause for these ellipsoid zone changes.
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Haller JA, Stalmans P, Benz MS, Gandorfer A, Pakola SJ, Girach A, Kampik A, Jaffe GJ, Toth CA. Efficacy of intravitreal ocriplasmin for treatment of vitreomacular adhesion: subgroup analyses from two randomized trials. Ophthalmology 2014; 122:117-22. [PMID: 25240630 DOI: 10.1016/j.ophtha.2014.07.045] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/28/2014] [Accepted: 07/29/2014] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To evaluate the efficacy of a single intravitreal injection of ocriplasmin 125 μg across relevant subpopulations of patients with symptomatic vitreomacular adhesion (VMA)/vitreomacular traction (VMT), including when associated with macular hole. DESIGN Two multicenter, randomized, placebo-controlled, double-masked, 6-month studies. PARTICIPANTS A total of 652 randomized patients (464 receiving ocriplasmin; 188 receiving placebo). METHODS A single intravitreal injection of ocriplasmin 125 μg or placebo in the study eye. MAIN OUTCOME MEASURES Prespecified subgroup analyses were conducted to evaluate the effects on the proportion of patients with nonsurgical resolution of focal VMA at day 28, nonsurgical full-thickness macular hole (FTMH) closure at month 6, and categoric improvement in best-corrected visual acuity (BCVA) at month 6. RESULTS Resolution of VMA at day 28 was achieved more often in younger patients (<65 years), eyes without epiretinal membrane, eyes with FTMH, phakic eyes, and eyes with a focal VMA ≤ 1500 μm. Eyes with FTMH width ≤ 250 μm were more likely to achieve nonsurgical FTMH closure. Categoric ≥ 2-line and ≥ 3-line improvement in BCVA occurred more often in younger patients (<65 years) and in patients with a lower baseline BCVA (<65 letters). Treatment differences in favor of ocriplasmin were generally observed across each subgroup of subpopulations studied. CONCLUSIONS Subgroup analyses confirmed the positive effect of ocriplasmin across relevant subpopulations.
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Affiliation(s)
| | | | | | - Arnd Gandorfer
- Department of Ophthalmology, Klinikum der LMU, Munich, Germany and MVZ, Memmingen, Munich, Germany
| | | | - Aniz Girach
- NightstaRx Ltd, London, UK (formerly of ThromboGenics NV)
| | - Anselm Kampik
- Department of Ophthalmology, Klinikum der LMU, Munich, Germany
| | - Glenn J Jaffe
- Duke Reading Center, Duke University School of Medicine, Durham, North Carolina
| | - Cynthia A Toth
- Duke Reading Center, Duke University School of Medicine, Durham, North Carolina
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Abstract
Ocriplasmin represents a new treatment option for numerous vitreoretinopathies involving an abnormal vitreomacular interface. While the drug may circumvent the traditional risks of surgical treatment, pharmacologic vitreolysis is not devoid of risk itself. This report presents two cases, one of vitreomacular traction syndrome and the other of a full-thickness macular hole, both of which were treated with an intravitreal injection of ocriplasmin. Notably, in both cases, vitreomacular traction of the macula appears to have been alleviated; however, failure to completely relieve vitreoretinal traction from the peripheral retina generated retinal breaks with one patient eventually developing a macula-involving retinal detachment. Thus, even in instances of ‘successful’ pharmacologic treatment of vitreomacular traction, continued follow-up evaluation is essential.
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Affiliation(s)
- Ruwan A Silva
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Darius M Moshfeghi
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Theodore Leng
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
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Abstract
PURPOSE To discuss the potential role of microplasmin (ocriplasmin) as a surgical adjunct to vitrectomy in pediatric vitreoretinopathies. METHODS Literature review of the laboratory and clinical evidence to date for the use of both autologous plasmin enzyme as an adjunct to vitrectomy and more recently recombinant microplasmin (ocriplasmin) as monotherapy for focal vitreomacular traction in adults. RESULTS Autologous plasmin enzyme is currently being used as a surgical adjunct to vitrectomy, with supporting Levels 2 and 3 published evidence in a range of pediatric vitreoretinopathies including Stage 5 retinopathy of prematurity and congenital X-linked retinoschisis. The availability of autologous plasmin enzyme is limited. In recent Phase 3 clinical trials, intravitreal ocriplasmin versus sham injection resulted in resolution of focal vitreomacular traction in 27% versus 10% (P < 0.001, n = 652). CONCLUSION Ocriplasmin may potentially be used as a surgical adjunct to vitrectomy in place of autologous plasmin enzyme. A Phase 2, randomized, placebo-controlled surgical trial is under way to assess this.
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13
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Simpson ARH, Petrarca R, Jackson TL. Vitreomacular adhesion and neovascular age-related macular degeneration. Surv Ophthalmol 2013; 57:498-509. [PMID: 23068973 DOI: 10.1016/j.survophthal.2012.01.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 01/30/2012] [Accepted: 01/31/2012] [Indexed: 02/05/2023]
Abstract
We explore the hypothesis that vitreomacular adhesion (VMA) and vitreomacular traction (VMT) play a role in the pathogenesis and clinical course of neovascular ("wet") age-related macular degeneration (AMD). Several biological theories are offered to explain this possible association, including direct tractional force, altered vitreous oxygenation, altered diffusion coefficients of intravitreal molecules, and alterations in the pharmacokinetics of intravitreal drugs. Release of VMT may improve the clinical course of neovascular AMD, and a few case series suggest that vitrectomy can lead to both a functional and anatomic improvement. A large, randomized, controlled clinical trial is underway, investigating pharmacologic release of VMA in eyes with neovascular AMD.
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Affiliation(s)
- Andrew R H Simpson
- King's College London and King's College Hospital, London, United Kingdom
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15
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Stalmans P, Benz MS, Gandorfer A, Kampik A, Girach A, Pakola S, Haller JA. Enzymatic vitreolysis with ocriplasmin for vitreomacular traction and macular holes. N Engl J Med 2012; 367:606-15. [PMID: 22894573 DOI: 10.1056/nejmoa1110823] [Citation(s) in RCA: 392] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Vitreomacular adhesion can lead to pathologic traction and macular hole. The standard treatment for severe, symptomatic vitreomacular adhesion is vitrectomy. Ocriplasmin is a recombinant protease with activity against fibronectin and laminin, components of the vitreoretinal interface. METHODS We conducted two multicenter, randomized, double-blind, phase 3 clinical trials to compare a single intravitreal injection of ocriplasmin (125 μg) with a placebo injection in patients with symptomatic vitreomacular adhesion. The primary end point was resolution of vitreomacular adhesion at day 28. Secondary end points were total posterior vitreous detachment and nonsurgical closure of a macular hole at 28 days, avoidance of vitrectomy, and change in best-corrected visual acuity. RESULTS Overall, 652 eyes were treated: 464 with ocriplasmin and 188 with placebo. Vitreomacular adhesion resolved in 26.5% of ocriplasmin-injected eyes and in 10.1% of placebo-injected eyes (P<0.001). Total posterior vitreous detachment was more prevalent among the eyes treated with ocriplasmin than among those injected with placebo (13.4% vs. 3.7%, P<0.001). Nonsurgical closure of macular holes was achieved in 40.6% of ocriplasmin-injected eyes, as compared with 10.6% of placebo-injected eyes (P<0.001). The best-corrected visual acuity was more likely to improve by a gain of at least three lines on the eye chart with ocriplasmin than with placebo. Ocular adverse events (e.g., vitreous floaters, photopsia, or injection-related eye pain--all self-reported--or conjunctival hemorrhage) occurred in 68.4% of ocriplasmin-injected eyes and in 53.5% of placebo-injected eyes (P<0.001), and the incidence of serious ocular adverse events was similar in the two groups (P=0.26). CONCLUSIONS Intravitreal injection of the vitreolytic agent ocriplasmin resolved vitreomacular traction and closed macular holes in significantly more patients than did injection of placebo and was associated with a higher incidence of ocular adverse events, which were mainly transient. (Funded by ThromboGenics; ClinicalTrials.gov numbers, NCT00781859 and NCT00798317.).
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Affiliation(s)
- Peter Stalmans
- Department of Ophthalmology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
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Zhang K, Zhang L, Weinreb RN. Ophthalmic drug discovery: novel targets and mechanisms for retinal diseases and glaucoma. Nat Rev Drug Discov 2012; 11:541-59. [PMID: 22699774 DOI: 10.1038/nrd3745] [Citation(s) in RCA: 235] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Blindness affects 60 million people worldwide. The leading causes of irreversible blindness include age-related macular degeneration, retinal vascular diseases and glaucoma. The unique features of the eye provide both benefits and challenges for drug discovery and delivery. During the past decade, the landscape for ocular drug therapy has substantially changed and our knowledge of the pathogenesis of ophthalmic diseases has grown considerably. Anti-angiogenic drugs have emerged as the most effective form of therapy for age-related macular degeneration and retinal vascular diseases. Lowering intraocular pressure is still the mainstay for glaucoma treatment but neuroprotective drugs represent a promising next-generation therapy. This Review discusses the current state of ocular drug therapy and highlights future therapeutic opportunities.
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Affiliation(s)
- Kang Zhang
- Department of Ophthalmology and Molecular Medicine Research Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China.
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