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Vitreoretina Ocriplasmin Efficacy – An Analysis of Real-world Results from 2013 to 2015 Baruch D Kuppermann Professor of Ophthalmology and Biomedical Engineering; Chief, Retina Service; Vice Chair, Academic Affairs, Ophthalmology School of Medicine, Gavin Herbert Eye Institute, University of California, Irvine, California, US Abstract As the eye ages, physiological events predispose it to posterior vitreous detachment. This normal ageing process can be complicated by persistent vitreomacular adhesion, which may develop into vitreomacular traction (VMT) accompanied by visual symptoms if forces are great enough to cause macular anatomical changes. Ocriplasmin represents a pharmacological treatment option for VMT resolution. The results of studies and cases reporting ocriplasmin treatment subsequent to US Food and Drug Administration (FDA) approval are presented. Analysis of 26 studies showed that 23 (88 %) reported VMT resolution efficacy results above 40 %, well higher than the 26.5 % efficacy reported in the two pivotal clinical trials. Subsequent analysis revealed patient baseline characteristics predicted to have higher VMT resolution. These clinical trial results were confirmed in 14 post-approval studies with subgroup analysis, consistently showing that patients with specific criteria had higher resolution than their non-criteria-matching counterparts. Visual acuity (VA) group averages were reported by 13 of 18 studies, with 12 (92 %) reporting VA improvement. Case reports of patients receiving ocriplasmin showed 10 of 15 (67 %) with VA improvement; the five cases reporting visual decline reported relatively short follow-up periods. A full understanding of ocriplasmin efficacy in clinical settings will help further identify ideal candidates for ocriplasmin treatment. Keywords Ocriplasmin, vitrectomy, vitreomacular adhesion, vitreomacular traction, full-thickness macular hole, vitreoretinal interface, posterior vitreous detachment Disclosure: Baruch D Kuppermann 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.
 Acknowledgements: Editorial assistance was provided by Meridius Health Communications, Inc. and funded by ThromboGenics. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: 17 October 2015 Accepted: 2 December 2015 Citation: European Ophthalmic Review, 2015;9(2):141–6 Correspondence: Baruch D Kuppermann, Professor of Ophthalmology and Biomedical Engineering; Chief, Retina Service; Vice Chair, Academic Affairs, Gavin Herbert Eye Institute, University of California, Irvine, Irvine, CA 92697, US. E: bdkupper@uci.edu The vitreoretinal interface is a complex structure that facilitates the attachment between the internal limiting membrane of the retina and the vitreous, a clear gel filling the posterior of the eye. 1,2 As the eye ages, a series of physiological events occurs to the vitreous, including liquefaction, which predisposes the eye to posterior vitreous detachment (PVD). 2 PVD is a common occurrence in ageing eyes, developing in 75 % of people over the age of 65. 3,4 PVD is exemplified by the complete separation of the posterior hyaloid membrane from the retinal surface; anomalous PVD represents partial detachment, which can lead to further pathological conditions. The normal process of PVD due to ageing may be complicated by the presence of persistent vitreomacular adhesion (VMA), which occurs when the vitreous cortex adheres to the macula after detaching from the surrounding retina. 2,3,5 VMA is typically asymptomatic and is not associated with changes to the macular architecture. However, VMA may develop into vitreomacular traction (VMT), if the forces are great enough to cause observable anatomical changes to the macular architecture. This can result in multiple visual disturbances, such as photopsia, micropsia and metamorphopsia, and can potentially exacerbate concomitant retinal conditions, such as diabetic macular oedema and age-related macular degeneration. 2,5–7 TOU CH MED ICA L MEDIA Strong or chronic VMT during PVD can result in the development of macular holes. 8–12 A full-thickness macular hole (FTMH) is a break in the macula that extends through all layers from the internal limiting membrane to the retinal pigment epithelium. 5 A FTMH is rated as small (<250 μm), medium (250–400 μm) and large (>400 μm), based on the recent classification from the International Vitreomacular Traction Study Group. 13 Nearly half of FTMHs are large at the time of detection/diagnosis. 2,13 An important advance in the understanding and treatment of VMT and FTMH was the development of optical coherence tomography (OCT) technology. OCT provides the basis for greater visualisation of vitreomacular anatomy and has allowed for standardisation in the definitions of VMA, VMT and FTMH. 13–15 This in turn has provided a more accurate understanding of both retinal anatomy and the pathophysiological processes of VMT and FTMH. 2 The importance of this technology is underscored by the fact that focal VMA can be first discovered on routine examination using OCT. 5,6,8,16 This provides an opportunity to appropriately manage these cases and follow them properly, and to make a decision on when and how to intervene. Use of OCT and standardisation of definitions and treatment algorithms will aid in the development and timing of appropriate treatments. 141