Ocriplasmin for treatment of vitreomacular traction and macular hole: A systematic literature review and individual participant data meta-analysis of randomized, controlled, double-masked trials

Ocriplasmin is used to treat vitreomacular traction (VMT), with or without full-thickness macular hole (MH). We systematically reviewed the evidence on ocriplasmin's effect on vitreomacular adhesion resolution (VMAR), MH closure, vitrectomy, and best-corrected visual acuity (BCVA) and investiga...

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Bibliographic Details
Published in:Survey of ophthalmology 2022-05, Vol.67 (3), p.697-711
Main Authors: Jackson, Timothy L., Haller, Julia, Blot, Koenraad H., Duchateau, Luc, Lescrauwaet, Benedicte
Format: Article
Language:English
Subjects:
Female
Fibrinolysin
Humans
Intravitreal Injections
macular hole
meta-analysis
ocriplasmin
Peptide Fragments
Retina
Retinal Diseases
Retinal Perforations - drug therapy
systematic review
Tomography, Optical Coherence
Traction
Treatment Outcome
Vision Disorders
Visual Acuity
vitreomacular traction
Vitreous Body
Vitreous Detachment - drug therapy
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Summary:Ocriplasmin is used to treat vitreomacular traction (VMT), with or without full-thickness macular hole (MH). We systematically reviewed the evidence on ocriplasmin's effect on vitreomacular adhesion resolution (VMAR), MH closure, vitrectomy, and best-corrected visual acuity (BCVA) and investigated the effect of baseline covariates on outcome. We applied individual participant data meta-analyses to the entire population and to subgroups defined by MH or epiretinal membrane (ERM) presence. Safety data were pooled and tabulated. Five randomized controlled trials (1,067 participants) were included. Six months after treatment, ocriplasmin achieved higher rates of VMAR and MH closure versus control, lowered vitrectomy odds, and increased the likelihood of a ≥10-letter BCVA increase. VMAR rates were lower when ERM, broad VMA (> 1500 µm), diabetic retinopathy, or pseudophakia were present and higher in younger participants, women, and eyes with MHs. Ocriplasmin-treated participants experienced more short-term visual impairment that was not predictive of final BCVA, as well as vitreous floaters, photopsia, photophobia, eye pain, blurred vision, and dyschromatopsia. The most common serious adverse events for ocriplasmin and control, respectively, were MH progression (22.5%, 17.3%), new MH (1.5%, 3.4%) and retinal detachment (0.8%, 1.2%). Ocriplasmin promotes VMAR and MH closure. Transient visual phenomena are not uncommon.
ISSN:0039-6257
1879-3304
DOI:10.1016/j.survophthal.2021.08.003