Retina. 2016 Dec;36(12):2290-2296. doi: 10.1097/IAE.0000000000001110.


Purpose: To assess outer retinal architectural alterations after intravitreal ocriplasmin with a novel automated ellipsoid zone (EZ) mapping algorithm.

Methods: A single-center, retrospective, consecutive case series of image analysis was performed. Quantitative assessment of EZ status imaged with spectral-domain optical coherence tomography was performed before and after single intravitreal injection of 0.125 mg of ocriplasmin (Jetrea, Thrombogenics). A novel EZ mapping algorithm was used to assess the EZ retinal pigment epithelium (RPE) central area, EZ-RPE macular volume, and en face EZ integrity based on the percentage of sampling areas with 20 μm or greater EZ-RPE thickness. Longitudinal assessment of these changes with custom optical coherence tomography reading software was completed. Clinical characteristics and outcomes were compared with these retinal changes.

Results: Nineteen eyes were included in this study. The retinal volume between EZ and RPE was significantly reduced at 1 week after ocriplasmin (P = 0.0036). Seven of 19 patients (36.8%) complained of color abnormalities or brightness reduction after injection. All of these seven patients had increased subretinal fluid after ocriplasmin and EZ attenuation. The EZ-RPE volume was reduced at 1 week (P = 0.0036), 1 month (P = 0.015) after ocriplasmin, and restored by 3 months. The area with EZ-RPE thickness below 20 μm was increased at 1 week (P = 0.046) after ocriplasmin and recovered with time.

Conclusion: Mapping of EZ is feasible to assess EZ-RPE volume and overall EZ integrity with en face thickness mapping. Alterations in EZ occur in a significant proportion of eyes after ocriplasmin therapy. The EZ-RPE volume and the EZ-RPE central foveal area typically recover to baseline by 3 months. This effect appears to be panretinal and associated with subjective symptoms.

MeSH terms

  • Aged
  • Female
  • Fibrinolysin / administration & dosage*
  • Fibrinolytic Agents / administration & dosage*
  • Humans
  • Macular Degeneration / drug therapy*
  • Male
  • Middle Aged
  • Peptide Fragments / administration & dosage*
  • Retinal Perforations / drug therapy*
  • Retinal Pigment Epithelium
  • Retrospective Studies
  • Tissue Adhesions / drug therapy
  • Tomography, Optical Coherence


  • Fibrinolytic Agents
  • Peptide Fragments
  • microplasmin
  • Fibrinolysin