Ocriplasmin in the treatment of vitreomacular traction – against

Summary Ocriplasmin is an enzyme that dissolves vitreal proteins as well as possibly proteins associated with visual function in the retina, choroid, and lens. The MIVI trials concluded that intravitreal Ocriplasmin was superior to an injection of placebo in altering the vitreoretinal interface of affected eyes, although it was accompanied by some, mainly transient, ocular adverse events. There are anecdotal reports of adverse events as well as early reports in the literature of previously unreported side effects, such as enlargement of the macular hole, zonular instability, and localised non‐rhegmatogenous retinal detachment. A recent BEAVRS survey in the UK reported lower macular hole closure rates and higher than expected adverse events. Furthermore, there have been conflicting views on the safety of Ocriplasmin with changes in the ellipsoid zone seen on OCT and changes seen on ERG indicating photoreceptor damage. The practical question asked by the retina specialist is the following: observe, inject or operate? Increased numbers of real world experience with Ocriplasmin and post marketing surveillance studies are needed.