Ocriplasmin for treatment of stage 2 macular holes: early clinical results

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.

Figure 1

Successful closure with ocriplasmin. A: Stage 2 macular hole. B: One week after ocriplasmin injection with separation of the posterior hyaloid and closure of the inner retina. C: One month after ocriplasmin injection with hole closure and outer retinal defects. D: Six months after ocriplasmin injection with persistent outer retinal defects and ellipsoid zone (EZ) disruptions.

Figure 2

Ocriplasmin failure A: Stage 2 macular hole prior to treatment. B: One week after ocriplasmin injection showing posterior vitreous detachment and enlargement of the macular hole. C: One month after ocriplasmin injection with further progression of intraretinal cystic changes and macular hole diameters. D: Seven months after surgical repair showing macular hole closure.

Figure 3

OCT measurements A: The average diameters in the one hole that closed with ocriplasmin were smaller than those that failed to close. B: The average diameters of those holes that failed to close with ocriplasmin showed enlargement from pre-injection to 1 week post-injection to 1 month post-injection. These were statistically significant changes (*) in basal diameter at one week (p=0.002) and one month (p=0.006) and apical diameter at one month (p=0.016).

Figure 4

EZ attenuation. A: Stage 2 macular hole prior to treatment. B: One week after ocriplasmin injection showing loss of the EZ nasally and attenuation of the EZ temporally. C: One month after ocriplasmin injection showing continued attenuation of the EZ nasally and temporally. D: Four months after surgery with continued subfoveal outer retinal defect and attenuation of EZ band, but some improvement in the EZ from prior OCT.