Bilateral vitreomacular traction resolved with a single intravitreal ocriplasmin injection

Scoping review of nonsurgical treatment options for macular holes

Macular holes (MH) are full-thickness retinal defects affecting central vision. While vitrectomy with inner limiting membrane (ILM) peel is the conventional MH treatment, non-surgical alternatives are gaining interest to mitigate surgical risks. This study conducted a comprehensive literature review and analysis of nonsurgical MH management. A systematic literature search was conducted on PubMed, Embase, Scopus, and the Cochrane Library from January 1, 1973, to September 13, 2023. Treatments included laser therapy, carbonic anhydrase inhibitors (CAIs), nonsteroidal antiinflammatory drugs (NSAIDs), steroids (topical, subtenons, peribulbar, intravitreal), intravitreal gas, anti-vascular endothelial growth factors and ocriplasmin injections. Data extraction covered study details, patient characteristics, MH features, treatment outcomes, and recurrence rates. The initial search yielded 3352 articles, refined to 83 articles that met inclusion criteria following screening. Overall reported anatomical closure rates were 36% with laser photocoagulation, 37% with intravitreal ocriplasmin, 55% with intravitreal gas. Closures were more frequently observed with topical NSAIDs (79%), steroids (84%) and CAIs (73%). Closures were more often observed in patients with smaller MH and in the presence of cystic macular oedema. Although non-surgical MH management approaches show potential for conservative therapy, evidence is limited to support routine use. Stage 1 and traumatic MH may benefit from a short period of observation, but the gold standard approach for full-thickness MH remains to be vitrectomy with ILM peel.

LONG-TERM OUTCOMES IN PATIENTS WITH VITREOMACULAR TRACTION TREATED WITH A SINGLE INTRAVITREAL INJECTION OF OCRIPLASMIN

PURPOSE

To report long-term outcomes in patients with vitreomacular traction injected with intravitreal ocriplasmin.

METHODS

Interventional case series.

PATIENTS

A 64-year-old woman and a 46-year-old woman.

RESULTS

In Case 1, a 64-year-old woman with focal vitreomacular traction with impending macular hole presented with a visual acuity of 20/80 +1 and was injected with ocriplasmin 11 days later. Visual acuity continued to improve and stabilized through 60 weeks of follow-up with a final visual acuity of 20/50. Vitreomacular traction release was confirmed by optical coherence tomography 6 weeks after injection.In Case 2, a 46-year-old woman with focal vitreomacular traction presented with a visual acuity of 20/60 and received ocriplasmin treatment the same day. Vitreomacular traction release was confirmed by optical coherence tomography 2 days later. After subsequent worsening of visual acuity, pneumatic retinopexy and pars plana vitrectomy were performed. Visual acuity continued to improve and stabilize throughout the 52-week follow-up with a final visual acuity of 20/25.

CONCLUSION

We present here two patients with focal vitreomacular traction treated with ocriplasmin and followed up long-term for up to one year. In both cases, visual acuity improved compared with baseline and stabilized after ocriplasmin treatment. These cases add to the growing literature demonstrating resolution of symptoms after ocriplasmin treatment over longer follow-up periods.