Moisseiev Joseph, Moroz Iris, Katz Gabriel
Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
JAMA Ophthalmol. 2014 Jun;132(6):709-13. doi: 10.1001/jamaophthalmol.2013.8223.
Assessing the effect of ocriplasmin availability on the management of full-thickness macular holes (MHs) is important for vitreoretinal surgeons and their patients. Such an assessment can indicate whether the use of ocriplasmin will bring a paradigm shift in treating MHs or will be just an additional option relevant to a small group of patients.
To classify the MHs evaluated in our institute by their stage and the presence of vitreomacular adhesion (VMA) and to identify eyes that were suitable candidates for ocriplasmin injection according to guidelines published by the Microplasmin for Intravitreous Injection-Traction Release Without Surgical Treatment (MIVI-TRUST) study group.
DESIGN, SETTING, AND PARTICIPANTS: All optical coherence tomographic studies of eyes with MHs performed between 2009 and 2013 were retrospectively reviewed. The scans were interpreted by 2 individuals, and for each hole the stage, size, and vitreomacular relationship were defined according to the definitions used in the MIVI-TRUST studies. One hundred thirty-five patients with full-thickness MHs evaluated at a public hospital were included in the study series. There were 82 women and 53 men, and the mean (SD) age was 67.3 (12.8) years.
The stage, size, and presence or absence of VMA were documented for each MH. The suitability for ocriplasmin intravitreal injection was determined according to the criteria described in the MIVI-TRUST reports.
Vitreomacular adhesion was present in 19 eyes with MH (14.1%). Of these, the hole size was 400 μm or less in only 9 eyes (6.7% of the series). Using the criteria of the MIVI-TRUST study exclusively, only these eyes were candidates for ocriplasmin injection. Assuming a closure success rate of 40%, as described in that study, only 2.7% of the patients in our series would have benefited from ocriplasmin injection.
Our findings indicate that ocriplasmin injection is an adequate choice for few patients with MHs. Pars plana vitrectomy will probably remain the treatment of choice for most eyes with MHs. This situation could change if MHs are detected earlier and treated while they are still small and have vitreomacular traction.
评估奥克纤溶酶可用性对全层黄斑裂孔（MH）治疗的影响，对玻璃体视网膜外科医生及其患者而言至关重要。这样的评估能够表明，使用奥克纤溶酶是否会给MH的治疗带来范式转变，还是仅仅是针对一小部分患者的额外选择。
根据我们研究所评估的MH的分期以及玻璃体黄斑粘连（VMA）情况进行分类，并根据玻璃体内注射微纤溶酶-无手术治疗的牵引松解（MIVI-TRUST）研究组发布的指南，确定适合注射奥克纤溶酶的眼睛。
设计、地点和参与者：对2009年至2013年间进行的所有MH患者的光学相干断层扫描研究进行回顾性分析。扫描结果由2名人员解读，根据MIVI-TRUST研究中使用的定义，确定每个裂孔的分期、大小和玻璃体黄斑关系。本研究系列纳入了在一家公立医院接受评估的135例全层MH患者。其中女性82例，男性53例，平均（标准差）年龄为67.3（12.8）岁。
记录每个MH的分期、大小以及VMA的有无。根据MIVI-TRUST报告中描述的标准，确定玻璃体内注射奥克纤溶酶的适用性。
19只MH患眼中存在VMA（14.1%）。其中，仅9只眼（占该系列的6.7%）的裂孔大小为400μm或更小。仅依据MIVI-TRUST研究的标准，只有这些眼睛是注射奥克纤溶酶的候选对象。假设如该研究中所述的闭合成功率为40%，在我们的系列患者中，只有2.7%的患者会从奥克纤溶酶注射中获益。
我们的研究结果表明，注射奥克纤溶酶对少数MH患者是一种合适的选择。对于大多数MH患眼，玻璃体切割术可能仍是首选治疗方法。如果能更早发现MH并在其仍较小且存在玻璃体黄斑牵引时进行治疗，这种情况可能会改变。
