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Brief Report |

Acute Panretinal Structural and Functional Abnormalities After Intravitreous Ocriplasmin Injection

Abigail T. Fahim, MD, PhD1; Naheed W. Khan, PhD1; Mark W. Johnson, MD1
[+] Author Affiliations
1Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
JAMA Ophthalmol. 2014;132(4):484-486. doi:10.1001/jamaophthalmol.2013.8142.
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Importance  Ocriplasmin cleaves fibronectin and laminin, components of the vitreous gel, and is used as a pharmacologic treatment for vitreomacular traction. Laminin is also found throughout multiple retinal layers. Ocriplasmin injection may lead to acute panretinal dysfunction in some eyes, but the mechanism of this toxic reaction has not been described.

Observations  We evaluated a 63-year-old woman demonstrating acute panretinal dysfunction after intravitreous ocriplasmin injection for a small macular hole with vitreomacular adhesion. Findings included visual acuity loss, visual field constriction, pupillary abnormalities, attenuated retinal arteries, loss of outer retinal signals on spectral-domain optical coherence tomography, and severely reduced electroretinography responses. B-waves were reduced more than A-waves were, suggesting postreceptoral dysfunction and decreased photoreceptor activity.

Conclusions and Relevance  Retinal dysfunction associated with intravitreous ocriplasmin injection is not limited to the macular region and seems to involve the entire retina. Enzymatic cleavage of intraretinal laminin is a biologically plausible mechanism for acute ocriplasmin retinal toxic effects.

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Figure 1.
Spectral-Domain Optical Coherence Tomography of the Right Eye Before Ocriplasmin Injection

The horizontal image shows a small full-thickness macular hole with vitreous adhesion to the inner layer flap.

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Figure 2.
Fundus Photographs and Horizontal Spectral-Domain Optical Coherence Tomography 9 Days After Ocriplasmin Injection in the Right Eye

A, The right eye (left) demonstrates a macular hole and attenuation of the retinal vasculature compared with the left eye (right). B, The right eye (left) demonstrates enlargement of the macular hole, with subretinal fluid and a peculiar shape to the hole edges. There is significant attenuation of the external limiting membrane (ELM), ellipsoid layer, and cone outer segment tips (COST) line compared with the healthy left eye (right). The retinal pigment epithelium (RPE) appears normal in each eye.

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Figure 3.
Electroretinography 9 Days After Ocriplasmin Injection in the Right Eye

The rod electroretinogram is severely reduced to less than 10% of normal in the right eye and is mildly subnormal in the left eye. The combined rod-cone response shows depressed A-waves and B-waves to 50% of normal in the right eye and is normal in the left eye. The photopic bright-flash electroretinogram demonstrates depressed A-waves and B-waves to 40% of normal in the right eye and is normal in the left eye. The 32-Hz flicker electroretinogram is depressed to 50% of normal in the right eye and is normal in the left eye. Oscillatory potential amplitudes are severely reduced in the right eye.

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