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Myopic macular hole detachment associated with intravitreal ocriplasmin
Li Yen Goh1, Lorenzo Motta1, Timothy L Jackson1,2
1Department of Ophthalmology, King's College Hospital, London, United Kingdom.
American Journal of Ophthalmology Case Reports
|July 9, 2020
Summary
Intravitreal ocriplasmin injection for macular holes may increase retinal detachment risk in high myopes. This case highlights potential complications, emphasizing careful patient selection and monitoring.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Pharmacology
Background:
- Intravitreal ocriplasmin is used to treat vitreomacular adhesion associated with full-thickness macular holes (FTMH).
- High myopia is a known risk factor for retinal detachment, and these patients were initially excluded from ocriplasmin trials.
Observation:
- A 71-year-old highly myopic female (–18.63 D) received ocriplasmin for a FTMH.
- Post-injection, she developed a large posterior macular hole retinal detachment.
- Despite multiple vitrectomies, the FTMH persisted, though reduced in size.
Findings:
- The macular hole retinal detachment may be linked to ocriplasmin's enzymatic action on the interphotoreceptor matrix in the context of FTMH and high myopia.
- Ocriplasmin's dual action (vitreous detachment induction and enzymatic digestion) could compromise neuroretinal adhesion.
Implications:
- Clinicians should consider the potential association between ocriplasmin and macular hole detachments in highly myopic eyes.
- This case underscores the importance of careful patient selection and risk-benefit assessment when using ocriplasmin in high myopes.
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