Abstract
BackgroundTo investigate, using optical coherence tomography angiography (OCT-A), changes in perfusion density and in the foveal avascular zone (FAZ) in eyes with idiopathic vitreomacular traction (VMT) after ocriplasmin injection.MethodsIn this pilot study, we enrolled sixteen VMT eyes treated with intravitreal ocriplasmin injection. Sixteen healthy eyes were considered as controls. Macular perfusion density in 3 plexuses [superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC)] was calculated at baseline and at 1 month after injection.ResultsAfter injection, VMT anatomically resolved in 9 eyes (56.2%), whereas 7 eyes (43.8%) achieved an incomplete VMT separation. Superficial capillary plexus perfusion density was reduced significantly after injection (from 0.427 ± 0.027 to 0.413 ± 0.028; p = 0.0146), while no differences were noted in the DCP (p = 0.2717) nor in the CC (p = 0.6848). Study-eye perfusion density was statistically similar to control eyes in all three plexuses, both at baseline and at follow-up. The FAZ in the SCP area remained unchanged after injection (p = 0.168) but was significantly inferior to controls both at baseline and at 1 month (0.198 ± 0.074 vs. 0.196 ± 0.070; p = 0.007).ConclusionsEyes with VMT have a perfusion density comparable to healthy controls, but a smaller FAZ. After ocriplasmin injection the perfusion density in the SCP is reduced, regardless the anatomical success. Limited by the small sample size and the pilot nature of the study, we found microvascular changes after ocriplasmin injection, which may be due to retinal traction release.
Highlights
To investigate, using optical coherence tomography angiography (OCT-A), changes in perfusion density and in the foveal avascular zone (FAZ) in eyes with idiopathic vitreomacular traction (VMT) after ocriplasmin injection
Continued traction on the macular region without vitreous release can lead to pathologic vitreomacular adhesion (VMA), producing either vitreomacular traction (VMT), characterized by anatomical distortion of the fovea, or macular hole (MH) formation [1]
Kashani et al used fluorescein angiography to show microvascular pattern alterations produced by vitreoretinal traction, Fig. 5 Box-and-whiskers plots of capillary perfusion density in the superficial capillary plexus (SCP)
Summary
To investigate, using optical coherence tomography angiography (OCT-A), changes in perfusion density and in the foveal avascular zone (FAZ) in eyes with idiopathic vitreomacular traction (VMT) after ocriplasmin injection. Incomplete separation of the posterior hyaloid at the macula is termed vitreomacular adhesion (VMA). Continued traction on the macular region without vitreous release can lead to pathologic VMA, producing either vitreomacular traction (VMT), characterized by anatomical distortion of the fovea, or macular hole (MH) formation [1]. Ocriplasmin (Jetrea; Thrombogenics, Belgium), a truncated form of human serine protease plasmin, is the first approved pharmacological alternative to surgical treatment for vitreomacular traction (VMT), even in association with small or intermediate MH. The enzyme is able to cleave laminin and fibronectin, which are molecules that attach the posterior hyaloid to the retinal surface, with the aim to resolve VMT [4]
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