Redesigning services for the management of vitreomacular traction and macular hole

Abstract

Vitreomacular traction (VMT) and VMT with macular hole (MH) are serious conditions, being associated with visual disturbance, for example, metamorphopsia, and diminished visual acuity (VA). Pars plana vitrectomy is the routine treatment for symptomatic VMT and VMT+MH. However, ocriplasmin has demonstrated favourable efficacy and safety in specific patient groups with VMT/MH and is now recommended as a treatment option for certain patients by the National Institute of Health and Care Excellence. This means that services for managing patients with VMT/MH may need to be revised, as patients can now potentially receive treatment earlier in the course of the disease. VMT triage clinics could provide a more efficient way of managing VMT/MH patients. Patient assessment should always include high-definition optical coherence tomography, as this is the most accurate means of assessing abnormalities in the vitreoretinal (VR) interface, and an accurate measurement of best-corrected VA. It has been proposed that patients with VMT+MH be managed as a routine 6-week referral, with the complete patient journey—from initial referral to treatment—taking no longer than 6 months. It is important that patients are entered onto VR surgical lists so that there is no delay if ocriplasmin treatment is unsuccessful. Patients will need appropriate counselling about the expected outcomes and possible side effects of ocriplasmin treatment. One-year follow-up data should be collected by treatment centres in order to evaluate the new VMT service.

Clinical characteristics and selection of treatment modality for patients with vitreomacular traction: real-world implementation of NICE guidance (TA297)

“…From our figures, using a catchment population of 850,000, we estimate a frequency of ocriplasmin use at 1.4 per 100,000 per year. 28 This discrepancy may well be partly due to the variation in patient selection for treatment and in particular the subjective interpretation of the definition of “symptomatic”, and what constitutes focal VMT on an OCT scan. Another factor may be the lack of guidance on coexisting macular pathology.…”

Ethnic variation in primary idiopathic macular hole surgery

“…Alternatively, ethnic-specific foveal anatomical factors may contribute to larger IMH. Furthermore, logistic 40 it is perhaps prudent that vitreoretinal units that treat multi racial populations consider ethnicity when counselling patients with regards to their treatment options. The limitations of our study must be acknowledged.…”

Mutational Analysis of Ocriplasmin to Reduce Proteolytic and Autolytic Activity in Pichia pastoris

“…Symptomatic vitreomacular adhesion or vitreomacular traction may cause edema, macular distortion and, form macular holes. This sight-threatening condition relates to decreased visual acuity, photopsia and, metamorphopsia [ 1 – 4 ]. Vitreomacular traction spontaneously clears up in 10–35% of the cases [ 5 , 6 ]; otherwise, it can progress into visual impairment [ 1 ].…”

“…Vigilant monitoring and pars plana vitrectomy constitute standard procedures for managing symptomatic vitreomacular adhesion [ 1 , 3 ]. Given the risk of damage to the retina caused by the surgery [ 7 ], proteolytic enzymes such as plasmin have been examined for the enzymatic release of retinal traction [ 8 ].…”