Ocriplasmin use for vitreomacular traction and macular hole: A meta-analysis and comprehensive review on predictive factors for vitreous release and potential complications

Purpose: We aimed to provide a meta-analysis of the factors affecting vitreomacular traction (VMT) resolution after ocriplasmin use. A comprehensive systematic review of the complications after ocriplasmin use for VMT and macular hole was also done.

Methods: A literature search in PubMed was performed for studies about ocriplasmin published before 30 June 2015. Then a meta-analysis of the factors affecting the VMT resolution after ocriplasmin use was done, providing the pooled odds ratios for each factor and 95 % confidence intervals (CIs). We also described the potential adverse events after ocriplasmin use in a systematic review.

Results: A total of 194 abstracts were screened and 19 eligible studies were included in the meta-analysis. Age <65 years, female gender, vitreomacular adhesion diameter <1500 μm, phakic lens status and epiretinal membrane absence were found as positive predictive factors for VMT resolution, while macular hole size <250 μm was significantly associated with macular hole closure at the meta-analytical level. Various complications after ocriplasmin use were reported by frequency, including mainly vitreous floaters, photopsias, visual acuity decrease, ellipsoid zone changes, subretinal fluid development, enlargement of macular hole, anterior segment changes and electroretinogram alterations. It has to be noted that significant methodological weaknesses were identified, such as the absence of control groups or lack of transparency in the recruitment process and the examination procedure.

Conclusions: It is important to carefully select patients for ocriplasmin injection, taking into account the various predictive factors for VMT resolution. Patients should be informed about the potential adverse events of ocriplasmin, although they mainly seemed to be transient and usually mild/moderate in severity, suggesting that ocriplasmin is a safe and effective new treatment alternative for VMT and macular hole. However, due to the limited study quality, the uncertainty concerning the efficacy of this new approach is increased.