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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
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: email@example.com
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
Tou ch MEd ica l MEdia
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 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