Coexistence of vitreomacular traction and exudative age-related macular degeneration. A case report

Vitreomacular traction is a common phenomenon causing a decrease in visual acuity, metamorphopsia, and disorders of central vision. The introduction of intravitreal ocriplasmin injection provided a new possibility of noninvasive treatment of this syndrome. The novelty of this case is that the ocriplasmin is a new treatment possibility and its combination with ranibizumab treatment has rarely been reported. The aim was to report a case of an 83-year-old man treated with intravitreal ocriplasmin and ranibizumab injections because of coexisting vitreomacular traction and exudative age-related macular degeneration. A patient was referred to our clinic due to complaints about progressive central visual acuity decrease and metamorphopsia in the right eye observed within the last year. Before intravitreal 125-μg ocriplasmin injection the patient underwent ophthalmic examinations including best corrected visual acuity, slit-lamp, and fundoscopy and optical coherence tomography. After diagnosing with exudative age-related macular degeneration the patient was referred to three loading doses of anti-VEGF therapy. Three weeks after ocriplasmin injection the patient’s best corrected visual acuity improved. Ophthalmic examinations revealed the occurrence of exudative age-related macular degeneration. After three loading doses of anti-VEGF therapy ophthalmic examinations disclosed vitreomacular traction release and retinal fluid absorption. Coexistence of vitreomacular diseases may be the reason for poor response to anti-VEGF treatment in patients with exudative age-related macular degeneration. Simultaneously, pharmacological vitreolysis using ocriplasmin injection may be an effective and safe method of vitreomacular traction treatment.