Ocriplasmin: A Welcome Option for Vitreomacular Disease

Vaidehi S. Dedania, MD; Sophie J. Bakri, MD


May 15, 2013


The clinical implications of this study are important for physicians and their patients. Vitrectomy has traditionally been the only treatment for vitreomacular traction and macular holes, but it is generally performed only after clinically significant vision loss (after vitreomacular traction) secondary to the risks associated with this procedure. Intravitreal ocriplasmin is emerging as a minimally invasive alternative to observation and vitrectomy for symptomatic vitreomacular traction and small macular holes.

An important limitation of these studies is that the data may not be applicable to patients with myopia greater than 8 diopters, macular holes larger than 400 µm, proliferative diabetic retinopathy, or neovascular age-related macular degeneration. Future studies should investigate intravitreal ocriplasmin in the aforementioned subgroups compared with a control group that receives no intravitreal injection.

Additional side effects of ocriplasmin reported in previous and preclinical trials include lens subluxation and dyschromatopsia. Lens subluxation was reported in 1 patient treated with a higher-than-recommended dose of ocriplasmin and in 100% of monkeys treated with 2 doses of ocriplasmin 28 days apart. Dyschromatopsia (yellowish vision) was reported in 2% of patients injected with ocriplasmin. Care must therefore be taken to exclude patients with a known history of pseudoexfoliation syndrome.