The predictability of ocriplasmin treatment effects: is there consensus among retinal experts? Results from the EXPORT study

Graefes Arch Clin Exp Ophthalmol. 2017 Jul;255(7):1359-1367. doi: 10.1007/s00417-017-3657-2. Epub 2017 Apr 7.


Purpose: To evaluate the agreement and predictability of ocriplasmin treatment effects among retinal experts (raters) by assessment of retinal imaging data of eyes treated for vitreomacular traction in nine different centers in Germany and Austria.

Methods: Retrospective cohort study. Combined confocal near-infrared scanning laser ophthalmoscopy and spectral-domain optical coherence tomography images (Spectralis® device, Heidelberg Engineering GmbH, Germany) from 136 eyes of 135 subjects were reviewed by 14 raters using an internet-based grading database and a standardized questionnaire. In addition to the images taken within 2 days prior to treatment, age, gender, and lens status were disclosed to the raters. Treatment success was defined as a complete cleavage of the posterior vitreous cortex at day 28±5. Main outcome was the agreement and predictability among raters for assessment of treatment success.

Results: Raters generally accepted starting ocriplasmin treatment (chance for treatment success ≥ 1%) in 22.4 to 69.1% (median 53.2%) of eyes (moderate intra- and interrater agreements with kappa-values of 0.6 and 0.48). The likelihood for a high potential treatment success (equal or higher than 25%) was judged by the raters in 43.4% to 86.0% (median 62.6%) of eyes (moderate intra- and fair interrater agreements with kappa-values of 0.56 and 0.22). Allocating eyes for high potential treatment success overall increased the odds by 3.07, with odds ratios of single raters up to 4.06 to 6.16.

Conclusions: These results underscore the importance of training health care providers in the evaluation of retinal imaging data and also to define characteristic morphological features better in the presence of vitreoretinal interface diseases. The better results of single raters in the predictability of treatment success by the allocation of eyes in the high-potential group indicates the high relevance of the meticulous analysis of retinal images.

Keywords: Image analysis; Macular hole; Macular traction; Ocriplasmin; Spectral-domain optical coherence tomography; Vitreomacular interface disease.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Consensus*
  • Female
  • Fibrinolysin / administration & dosage*
  • Follow-Up Studies
  • Humans
  • Intravitreal Injections
  • Male
  • Middle Aged
  • Ophthalmoscopy
  • Peptide Fragments / administration & dosage*
  • ROC Curve
  • Retina / drug effects
  • Retina / pathology*
  • Retinal Perforations / diagnosis
  • Retinal Perforations / drug therapy*
  • Retinal Perforations / physiopathology
  • Retrospective Studies
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Visual Acuity*


  • Peptide Fragments
  • microplasmin
  • Fibrinolysin