Effect of Ocriplasmin on the Management of Macular Holes Assessment of the Clinical Relevance of Ocriplasmin

IMPORTANCE Assessing the effect of ocriplasmin availability on the management of full-thickness macular holes (MHs) is important for vitreoretinal surgeons and their patients. Such an assessment can indicate whether the use of ocriplasmin will bring a paradigm shift in treating MHs or will be just an additional option relevant to a small group of patients. OBJECTIVES To classify the MHs evaluated in our institute by their stage and the presence of vitreomacular adhesion (VMA) and to identify eyes that were suitable candidates for ocriplasmin injection according to guidelines published by the Microplasmin for Intravitreous Injection-Traction Release Without Surgical Treatment (MIVI-TRUST) study group. DESIGN, SETTING, AND PARTICIPANTS All optical coherence tomographic studies of eyes with MHs performed between 2009 and 2013 were retrospectively reviewed. The scans were interpreted by 2 individuals, and for each hole the stage, size, and vitreomacular relationship were defined according to the definitions used in the MIVI-TRUST studies. One hundred thirty-five patients with full-thickness MHs evaluated at a public hospital were included in the study series. There were 82 women and 53 men, and the mean (SD) age was 67.3 (12.8) years. MAIN OUTCOMES AND MEASURES The stage, size, and presence or absence of VMA were documented for each MH. The suitability for ocriplasmin intravitreal injection was determined according to the criteria described in the MIVI-TRUST reports. RESULTS Vitreomacular adhesion was present in 19 eyes with MH (14.1%). Of these, the hole size was 400 pm or less in only 9 eyes (6.7% of the series). Using the criteria of the MIVI-TRUST study exclusively, only these eyes were candidates for ocriplasmin injection. Assuming a closure success rate of 40%, as described in that study, only 2.7% of the patients in our series would have benefited from ocriplasmin injection. CONCLUSIONS AND RELEVANCE Our findings indicate that ocriplasmin injection is an adequate choice for few patients with MHs. Pars plana vitrectomy will probably remain the treatment of choice for most eyes with MHs. This situation could change if MHs are detected earlier and treated while they are still small and have vitreomacular traction.