Ocriplasmin limited as a macular hole management option

For a small percentage of patients who have macular holes, ocriplasmin injection represents an adequate treatment option; however, for most patients, pars plana vitrectomy will likely remain the treatment of choice.

That was the finding of researchers at Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. They retrospectively reviewed all optical coherence tomographic studies performed at Goldschleger Eye Institute between 2009 and 2013 of eyes with macular holes. The researchers sought to classify the holes by stage and by presence of vitreomacular adhesion in order to identify eyes that were suitable candidates for ocriplasmin injection (as set forth in the guidelines published by the Microplasmin for Intravitreous Injection–Traction Release Without Surgical Treatment (MIVI-TRUST) study group).

The researchers documented the stage and size of each macular hole, as well as the presence or absence of vitreomacular adhesion in 135 patients with full-thickness macular holes. They found vitreomacular adhesion in 19 eyes; of these, only 9 had a macular hole size of 400 μm or less, meaning only 6.7% of the eyes studied were candidates for ocriplasmin injection, according to the criteria of the MIVI-TRUST study. As the MIVI-TRUST describes a closure success rate of 40%, the researchers conclude that only 2.7% of the patients in this study would have benefited from ocriplasmin injection. According to the researchers, the results might have been different if the macular holes had been detected earlier and treated while they were smaller and still had vitreomacular traction.

According to this assessment, the researchers note although ocriplasmin injection offers an additional treatment option for a small group of patients, it does not represent a paradigm shift in treating macular holes.

To read an abstract of the study, which was published in JAMA Ophthalmology, click here.