Floaters and reduced contrast sensitivity after successful pharmacologic vitreolysis with ocriplasmin

To describe the onset of floaters and reduction in contrast sensitivity (CS) following successful pharmacologic vitreolysis with ocriplasmin for the treatment of vitreo-macular traction (VMT) in a patient with previously normal CS.

A 65-year-old woman with a past ocular history of normal visual acuity (VA = 20/26) and contrast sensitivity (1.81% Weber) presents with a 4-month history of distortions. VA decreased to 20/40 and Optical Coherence Tomography (OCT) demonstrated VMT. Pharmacologic vitreolysis was performed with intravitreal ocriplasmin. Ten weeks later the patient complained of floaters and was found to have a PVD and complete resolution of VMT. VA was still 20/40, but contrast sensitivity decreased by more than 100% to 3.77%Weber. After 6 months of attempted coping, this did not improve, so limited vitrectomy was performed. Post-operative VA = 20/26 and CS improved by 46% from 3.77%W to 2.03%W (normal).

and importance: This case highlights a little discussed consequence of PVD induction by successful pharmacologic vitreolysis - the development of clinically significant floaters. The resulting reduction of contrast sensitivity was normalized by limited vitrectomy, strongly suggesting that the detached vitreous was the cause.