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Ocriplasmin for symptomatic vitreomacular adhesion.

James E Neffendorf1, Varo Kirthi, Edward Pringle

  • 1Department of Ophthalmology, King's College Hospital, Normanby Building, Denmark Hill, London, UK, SE5 9RS.

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|October 18, 2017
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Intravitreal ocriplasmin injection effectively treats symptomatic vitreomacular adhesion (sVMA), promoting vitreous adhesion release and improving visual acuity. However, it is associated with increased ocular adverse events and may still require pars plana vitrectomy in some cases.

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Area of Science:

  • Ophthalmology
  • Retinal Diseases
  • Pharmacological Treatments

Background:

  • Symptomatic vitreomacular adhesion (sVMA) causes visual loss, traditionally managed with pars plana vitrectomy (PPV).
  • Enzymatic vitreolysis using intravitreal ocriplasmin offers a less invasive treatment alternative for sVMA.

Purpose of the Study:

  • To evaluate the efficacy and safety of ocriplasmin compared to sham or placebo for treating sVMA.
  • To assess ocriplasmin's impact on VMA release, macular hole closure, posterior vitreous detachment, visual acuity, and need for vitrectomy.

Main Methods:

  • Systematic review of four randomized controlled trials (RCTs) involving 932 eyes with sVMA.
  • Intervention: Intravitreal ocriplasmin injection (125 μg).
  • Comparisons: Sham or placebo injection; outcomes assessed at 28 days and six months.

Main Results:

  • Ocriplasmin significantly increased VMA release, macular hole closure, and complete posterior vitreous detachment (PVD) within 28 days (high-certainty evidence).
  • Ocriplasmin improved best-corrected visual acuity (BCVA) by at least 3 lines in 6 months and reduced the need for vitrectomy (moderate-certainty evidence).
  • Increased ocular adverse events were observed with ocriplasmin compared to controls; long-term safety data remains limited.

Conclusions:

  • Ocriplasmin demonstrates efficacy in treating sVMA, offering benefits in VMA release and visual improvement.
  • Despite its effectiveness, ocriplasmin treatment is linked to a higher incidence of ocular adverse events.
  • Further large-scale RCTs are recommended to compare ocriplasmin with alternative sVMA management strategies and assess long-term safety.