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Retina Ocriplasmin for the Treatment of Symptomatic Vitreomacular Adhesion/Traction Baruch D Kuppermann, MD, PhD Professor of Ophthalmology and Biomedical Engineering; Chief, Retina Service; Vice-Chair, Clinical Research, Ophthalmology School of Medicine, Gavin Herbert Eye Institute, University of California, Irvine, California, US Abstract Ocriplasmin has recently been introduced as a new treatment option for patients with symptomatic vitreomacular adhesion/vitreomacular traction (VMA/VMT). Understanding its potential as well as its limitations is crucial as it becomes an additional tool in the management of these diseases. 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. Efficacy data from ocriplasmin use in a clinical setting support the subanalysis of the phase III clinical trial data. This analysis demonstrated that certain baseline ocular characteristics, namely focal VMA, and absence of epiretinal membrane, are predictive of VMA resolution. Safety findings show that the overall percentage of patients experiencing adverse events during the clinical trial program was low in ocriplasmin-treated patients. Postmarketing surveillance data corroborate findings from the phase III trials, and provide additional insights into the characterization of the safety profile of this new treatment option. Keywords Vitreomacular traction, vitreomacular adhesion, ocriplasmin, posterior vitreous detachment, full-thickness macular hole, vitrectomy Disclosure: Baruch D Kuppermann, MD, PhD, has received clinical research funding from Alcon, Allegro, Allergan, Genentech, GSK, Neurotech, Ophthotech, Regeneron, and ThromboGenics, and has been a consultant to AcuFocus, Aerpio, Alcon, Alimera, Allegro, Allergan, Ampio, Genentech, Neurotech, Novartis, Ophthotech, Regeneron, SecondSight, Staar Surgical, Teva, and ThromboGenics. Acknowledgments: Editorial assistance was provided by Meridius Health Communications, Inc. (San Diego, AC, US) and funded by ThromboGenics. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: January 25, 2015 Accepted: February 27, 2015 Citation: US Ophthalmic Review, 2015;8(1):55–9 Correspondence: Baruch D Kuppermann, MD, PhD, Professor of Ophthalmology and Biomedical Engineering; Chief, Retina Service; Vice-Chair, Clinical Research, Gavin Herbert Eye Institute, University of California, Irvine, 850 Health Sciences Road, Irvine, CA 92697, US. E: Support: The publication of this article was supported by ThromboGenics. 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). 1,2 In some cases, however, incomplete VRI separation can result in anomalous PVD with the potential for the development of pathologic features. 2,3 As defined by the International Vitreomacular Traction Study Group classification system, 2 anomalous PVD is a partial vitreous detachment with persistent attachment in the macular region, resulting in tractional deformation of retinal tissue. Elevation of the 70 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. 4 The presence of pseudocysts frequently is associated with vision impairment, and once traction is released, pseudocysts generally resolve with improvement in vision. 5 Both VMA and VMT can be subclassified into either focal (≤1,500 µm) or broad (>1,500 µm) adhesions based on attachment size (see Table 1). Focal areas of vitreous attachment with traction tend to distort the foveal surface, whereas broad areas of attachment with traction Tou c h ME d ica l ME d ia