Flat Electroretinography and Acute Visual Loss After Ocriplasmin Injection for Vitreomacular Adhesion Complicating Macular Schisis

Abstract

A 53-year-old woman with macular and diffuse retinoschisis complicated by presumed vitreomacular traction underwent unilateral intravitreal ocriplasmin injection. Within hours after injection, she noted a loss of vision and the perception of "negative" images in the treated eye. Electrophysiologic testing revealed flat waveforms, and optical coherence tomography (OCT) showed initial decreased central macular thickness at day 1, followed by massive increased macular thickness with subfoveal neurosensory retinal detachment at 1 week. Her central macular thickness on OCT slowly returned to baseline during a period of 1 month until development of a macula-off rhegmatogenous retinal detachment at 6 months after injection. The authors believe this unique case of vitreomacular adhesion and macular schisis complicated by post-injection visual loss and electroretinography changes may offer further insight into this unusual complication.

Electroretinographic evaluations of retinal function before, just after and after intravitreal injections

“…Although these changes may be transient and generally do not cause severe and permanent adverse changes, we should remember that the number of intravitreal injections is rapidly increasing, and it may be performed repeatedly on the same eye. Intravitreal injection-associated visual depression has been reported 45 46 . Although the correlations between the number of previous IVIs and the changes in the ERG parameters were not significant, a possibility that repeated intravitreal injections might lead to permanent reductions should be considered especially in eyes with risk factors such as glaucoma, ocular hypertension, uveitis, and optic neuropathy.…”

Ocriplasmin: who is the best candidate?

“…Retinal toxicity after ocriplasmin injection has variable manifestations. 129 Reported structural changes include vascular constriction, 130 ellipsoid layer abnormalities (thinning, disruption, irregularity), 107 , 123 , 130 – 136 decreased reflectivity that persisted for 2 months after treatment, 137 abnormal autofluorescence, 106 , 126 , 127 , 138 SRF collection, 106 , 107 , 139 , 140 temporary separation of retina from RPE, 138 macular hole enlargement, 23 , 130 and macular detachment. 129 Interestingly, central serous chorioretinopathy, a type of SRF collection, has been noted up to 17 months after injection of ocriplasmin, and despite FTMH resolution.…”

“…Functionally, the retina has shown decreased (sometimes, flat) ERG 107 , 133 , 137 , 140 responses, with progressive nyctalopia, 106 light adaptation difficulties, 142 progressive photopsias 141 and visual field defects. 137 Some of these complications have also been seen in animal models.…”