Ocriplasmin versus vitrectomy for the treatment of macular holes

To compare the anatomical and visual outcomes of patients with bilateral macular holes (MH) who have been treated with pars plana vitrectomy in one eye and intravitreal ocriplasmin in the fellow eye. Multicentre, retrospective case series. Twenty-two eyes of 11 patients with bilateral MH treated with vitrectomy in one eye and ocriplasmin in the other were included. Patients were followed-up by 5 vitreoretinal surgeons from 3 retinal practices in Canada. All charts were reviewed for data collection, and optical coherence tomography (OCT) scans pre- and posttreatment were evaluated. MH closed primarily in 36.4% (n = 4) of the ocriplasmin-treated eyes and in 90.9% (n = 10) of the vitrectomy-treated eyes (p = 0.031). The 4 successfully treated ocriplasmin MH were preceded by a vitreomacular traction (VMT) release. Three additional ocriplasmin-treated eyes achieved a VMT release without MH closure. All persistent MH (100%) closed with subsequent vitrectomy, with no significant difference in final best-corrected visual acuity (BCVA) between those who achieved MH closure with primary or secondary interventions (p = 0.073). Final BCVA improved from logMAR 0.85 ± 0.34 to 0.37 ± 0.22 (p = 0.005) in the vitrectomy eyes and from 0.56 ± 0.28 to 0.28 ± 0.16 (p = 0.009) in the ocriplasmin eyes, with no significant difference in final BCVA between treatments (p = 0.306). Postoperative ellipsoid zone disruption persisted more frequently in vitrectomy-treated eyes. Both procedures were associated with improved visual outcomes, but eyes initially treated with vitrectomy had a higher primary MH closure rate. On OCT, patients had more outer structural changes in vitrectomy eyes than in ocriplasmin eyes. Comparer les résultats anatomiques et visuels chez des patients ayant des trous maculaires (TM) bilatéraux, dont l’un a été traité au moyen d’une vitrectomie par la pars plana et l’autre, par une injection intravitréenne d'ocriplasmine. Étude rétrospective multicentrique d’une série de cas 22 yeux de 11 patients ayant des TM bilatéraux, dont l’un a été traité par vitrectomie et l’autre, par l'ocriplasmine. Les patients ont été suivis par 5 spécialistes de la chirurgie vitréorétinienne dans 3 cliniques de la rétine du Canada. Tous les dossiers ont été passés en revue aux fins de la collecte des données, et on a comparé des clichés obtenus par tomographie par cohérence optique (OCT) réalisés avant et après le traitement. L’intervention primaire a permis la fermeture des TM dans 3