Chatziralli Irini, Theodossiadis George, Parikakis Efstratios, Datseris Ioannis, Theodossiadis Panagiotis
2nd Department of Ophthalmology, Ophthalmiatrion Athinon, Athens, Greece.
2nd Department of Ophthalmology, Henry Dunant Hospital, Athens, Greece.
Graefes Arch Clin Exp Ophthalmol. 2016 Feb;254(2):223-33. doi: 10.1007/s00417-015-3031-1. Epub 2015 May 5.
To evaluate prospectively the anatomical and functional results after ocriplasmin injection in patients with vitreomacular traction (VMT), or macular hole (MH) combined with VMT, providing the real-life experience of three centers, using spectral domain-optical coherence tomography (SD-OCT).
Twenty-four patients with VMT (17 with VMT alone and 7 with an MH combined with VMT) were treated with a single ocriplasmin injection and followed-up prospectively at baseline, day 1, 7, 28 and the last examination of the follow-up for each patient (range: 30-127 days). Best-corrected visual acuity (BCVA) and SD-OCT were performed for patient assessment, while various adverse events were recorded and analysed. At baseline, univariate analysis was also performed to examine the potential predictive factors for VMT release.
66.7 % of patients presented VMT release at the end of the follow-up, while 28.6 % exhibited MH closure. Baseline positive predictive factors for VMT release were young age, being female, phakic lens status, increased vitreofoveal angle, V-shaped and loose vitreomacular adhesion, small adhesion area, thin vitreous strands at the adhesion site and absence of an epiretinal membrane. Four new cases of ellipsoid line changes and subretinal fluid development became evident at day 7 compared to baseline. Lamellar macular hole (LMH) in four cases was first noticed at day 28 post injection. Formation of cystoid macular edema (CME) was noticed in three new cases at day 28 compared to baseline.
Our study demonstrated a VMT release rate of 66.7 %. Apart from the known baseline factors that influence VMT release after ocriplasmin injection, the size of the vitreofoveal angle, a V-shaped and loose vitreomacular adhesion, a small adhesion area, and thin vitreous strands at the adhesion site, could additionally affect the outcome of VMT release. In addition, we studied when VMT release and concomitant events occur and for how long the induced complications lasted.
采用频域光学相干断层扫描（SD-OCT）前瞻性评估玻璃体内注射奥克纤溶酶治疗玻璃体黄斑牵引（VMT）或黄斑裂孔（MH）合并VMT患者的解剖学和功能结果，提供三个中心的实际经验。
24例VMT患者（17例单纯VMT，7例MH合并VMT）接受单次奥克纤溶酶注射治疗，并在基线、第1天、第7天、第28天以及每位患者随访的最后一次检查（范围：30 - 127天）进行前瞻性随访。采用最佳矫正视力（BCVA）和SD-OCT对患者进行评估，同时记录并分析各种不良事件。在基线时，还进行单因素分析以检查VMT松解的潜在预测因素。
66.7%的患者在随访结束时出现VMT松解，28.6%的患者黄斑裂孔闭合。VMT松解的基线阳性预测因素包括年龄较小、女性、晶状体状态、玻璃体黄斑角度增加、V形和松弛的玻璃体黄斑粘连、粘连面积小、粘连部位玻璃体条索细以及无视网膜前膜。与基线相比，第7天有4例新出现椭圆体线改变和视网膜下液形成。4例板层黄斑裂孔在注射后第28天首次被发现。与基线相比，第28天有3例新出现囊样黄斑水肿（CME）形成。
我们的研究显示VMT松解率为66.7%。除了已知的影响奥克纤溶酶注射后VMT松解的基线因素外，玻璃体黄斑角度大小、V形和松弛的玻璃体黄斑粘连、粘连面积小以及粘连部位玻璃体条索细，可能会额外影响VMT松解的结果。此外，我们研究了VMT松解和伴随事件何时发生以及诱导并发症持续多长时间。
