Symptomatic vitreomacular adhesion (VMA): Diagnosis, pathologic implications, and management

Dr. Kaiser: The ability to treat symptomatic VMA, particularly early macular holes, with pharmacologic vitreolysis offers an efficient and safe way to improve our patients symptoms without requiring surgery or facedown positioning. Moreover, the therapy may help us if surgery is required in the future, as the vitreous is more liquefied and easier to peel. Dr. Brown: The addition of ocriplasmin will be a welcome addition to the armamentarium of vitreoretinal surgeons. The agent will be first used in patients with impending macular holes and small holes with persistent VMT at the edges. If multiple injections (or novel injection techniques) can result in reliable pharmacologic vitreolysis, I can easily see the agent being used routinely before vitreoretinal surgery and possibly as a prophylactic agent in diabetic patients prior to the development of proliferative disease. Dr. Humayun: As the field of enzymatic vitreolysis continues to advance and FDA-approved methodologies become available, there is no doubt that such an approach will be used to treat symptomatic VMA. Dr. Dugel: There are three forces that I believe will come together to make ocriplasmin a very valuable drug for the retina specialist. The first force is the advent of technological advances with OCT that allow us to easily visualize VMA. The second force is that all retina specialists are adept at performing an intravitreal injection. The third force is that we currently employ a watch-and-wait strategy for many of our patients due to the lack of options for a safe, noninvasive procedure. If ocriplasmin becomes available, I believe that retina practices are prime to adopt this agent for pharmacologic vitreolysis.