New Study in Ocriplasmin for the Treatment of Symptomatic Vitreomacular Adhesion/Traction

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US Ophthalmic Review, a peer-reviewed, open access, bi-annual Ophthalmology journal publish cutting-edge article by Baruch D Kuppermann.

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In this article the overall efficacy and safety of ocriplasmin are reviewed, focusing on the results from the phase III clinical trials as well as recently published case reports and postmarketing data analysis.

Recent advancements in imaging technology have allowed a more in-depth understanding of the diseases of the vitreoretinal interface (VRI), and have also changed how we evaluate the effectiveness of different treatment options. Until the development of optical coherence tomography (OCT), no practical method was widely available for visualizing and evaluating diseases of the VRI, and no consensus on the definition and classification of these diseases had been developed.

The development of OCT imaging technology has allowed better visualization of the complex and inevitable set of events that occur as the eye ages. Concurrent liquefaction of the vitreous gel and progressive posterior vitreous cortex separation ultimately lead to, in most eyes, nonpathologic posterior vitreous detachment (PVD). In some cases, however, incomplete VRI separation can result in anomalous PVD with the potential for the development of pathologic features. As defined by the International Vitreomacular Traction Study Group classification system, anomalous PVD is a partial vitreous detachment with persistent attachment in the macular region, resulting in tractional deformation of retinal tissue. Elevation of the cortical vitreous above the retinal surface, with the vitreous remaining attached within a 3 mm radius of the fovea, is defined as vitreomacular adhesion (VMA).2 Importantly, in the case of VMA, which is a normal part of the aging process in many eyes, the retina displays no change in contour or morphologic features on OCT, and therefore people with VMA generally experience no visual impairment. In some cases, the progression of PVD can lead to periods of excessive traction on the macula and distortion of the retinal architecture, which is then characterized as vitreomacular traction (VMT). Such traction can result in intraretinal pseudocyst formation, elevation of the fovea from the retinal pigment epithelium (RPE), or a combination that can result in reduced or distorted vision. The presence of pseudocysts frequently is associated with vision impairment, and once traction is released, pseudocysts generally resolve with improvement in vision.

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Barney Kent