Limited coverage drugs – ocriplasmin

For the treatment of symptomatic vitreomacular adhesion (VMA) confirmed through optical coherence tomography.

AND

Administered by a retinal specialist.

Excluded:

Coverage cannot be considered if patient has any of the following:

• large diameter macular holes (> 400 micrometre), or
• high myopia (> 8 dioptre spherical correction or axial length > 28 millimetre), or
• aphakia, or
• history of retinal detachment, or
• lens zonule instability, or
• recent ocular surgery or intraocular injection (including laser therapy), or
• proliferative diabetic retinopathy, or
• ischemic retinopathies, or
• retinal vein occlusions, or
• exudative age-related macular degeneration, or
• vitreous hemorrhage.

One injection per eye (lifetime maximum)