OCT features associated with vitreomacular traction release and macular hole size progression following treatment with ocriplasmin

Abstract

To evaluate OCT features for vitreomacular traction (VMT) release and change in macular hole (MH) size after treatment with ocriplasmin. Patients who had undergone treatment with ocriplasmin for VMT with or without MH ≤400µm were included. Main outcomes were VMT release, and changes in minimum linear diameter (MLD) MH size at 4 weeks in MHs that persisted. OCT features evaluated were central retinal thickness, vitreomacular adhesion length, posterior vitreous cortex (PVC) insertion angles 500µm from the insertion points and MLD size. Sixty patients were included, 37 had isolated VMT and 23 VMT with a MH. Four weeks after ocriplasmin injection the overall VMT release rate was 66.7% (40/60); 64.9% (24/37) in eyes with isolated VMT and 69.6% (16/23) in eyes with MH. VMT release was associated with younger age (p=0.02). MH closure was achieved in 26.1% (6/23) and was associated with a smaller ratio of the temporal to the nasal PVC angle (p<0.01). Of the 17 persistent MHs, 76.5% (13/17) increased in MLD size from baseline 186 (±78) to 358 (±133) µm (p<0.001). Progression in MLD size showed a negative linear association with the size of the nasal PVC angle (R2=0.39, p=0.002), and a positive linear association with the ratio of the temporal to nasal PVC angle (R2=0.39, p=0.002). In patients with VMT associated MHs, the risk of MH enlargement following ocriplasmin is negatively correlated with the nasal PVC angle size and is increased if the ratio of the temporal to nasal angle is >1.