HAMBURG — Clinical trials on ocriplasmin, including subgroup analysis of best responders, have shown patient selection plays a crucial role in the success of the therapy and may account for discrepancies in response rate from site to site, according to a speaker here.
“Ocriplasmin is not the same as other intravitreal injections we are currently utilizing in clinical practice. Who and how we inject may be important,” Baruch Kuppermann, MD, said at the Euretina meeting.
He shared his tips for using ocriplasmin (Jetrea, ThromboGenics) with the audience.
“Inject early in the day and early in the week because patients are likely to call a few hours later as symptoms appear,” he said.
The first week is crucial in this respect because the effects of the drug on the vitreous create symptoms that can scare patients.
“Advise patients that they are very likely to have symptoms including photopsia and decreased VA. Warn them, but also reassure them that symptoms are transient and will resolve spontaneously,” he said.
Optical coherence tomography should always be performed on the day of the treatment before removing ocriplasmin from the freezer because traction may have released spontaneously.
Injection should be performed as posteriorly as possible, burying the 1/2 inch needle to the hub.
“Consider laying the patient back for up to 30 minutes after the injection while still in the office. Ocriplasmin autocatalyzes, so getting the drug to the macula efficiently is key,” Kuppermann said.
Finally, he recommended taking into account the factors that have been so far identified as predictive of good response.
“Avoid injecting people with epiretinal membranes and consider that focal adhesions are more likely to respond compared to broad adhesions,” he said.
Disclosure: Kuppermann is consultant to ThromoGenics, Alcon and Novartis.