Jetrea For Vitreo Retinal Surgery
The FDA has approved ocriplasmin, or Jetrea, for the treatment of vitreomacular adhesion (VMA). Jetrea chemically causes a posterior vitreous detachment (PVD) and may avoid vitrectomy for many retinal patients.
The new drug, Jetrea, is delivered as an intraocular injection into the vitreous. The resultant chemically induced posterior vitreous detachment may stop or improve conditions involving the vitreo-macular interface, including; vitreomacular traction, or vitreomacular adhesion, epiretinal membranes and macular holes.
What is Vitreomacular Adhesion?
Vitreomacular adhesion is part of a spectrum of surgical macular conditions including epiretinal membranes, macular holes and VMA whereby the vitreomacular interface causes traction on the macula.
VMA, the more mild of the three, is a condition whereby the vitreous will "tug" or "pull" on the macula to cause a small amount of macular edema. We used to call this VMT, or vitreomacular traction.
On the other end of the spectrum are macular holes and epiretinal membranes.
For the purposes of this post, VMT and VMA are synonymous.
How to Diagnose VMA
- ● Macula may be normal by SLE/90 D
- ● No obvious PVD
- ● OCT demonstrates loss of foveal pit
Posterior Vitreous Detachment
When we are born, the vitreous naturally overlays the macula. This vitreo-macular interface has the potential to cause epiretinal membranes (ERM), macular holes and vitreomacular adhesion (VMA). Causing a PVD can possibly cure, improve, or repair the macular problem by mechanically disrupting the physical traction on the macula. Vitrectomy is the Gold Standard
The cure for ERM, MH and VMT has been vitrectomy. Vitrectomy is highly effective way to separate the vitreous from the macula. This is a crucial step in peeling ERMs, fixing macular holes and curing VMT/VMA. When to Refer Your Patients
There are two situations where I see Jetrea potentially useful in the clinical setting. Patients suffering with mild vision loss or distortion, so called "symptomatic VMA," due to vitreomacular adhesion might consider Jetrea. For certain situations where surgery is not possible, Jetrea can be injected in the office with the drug taking effect within several days. I also see Jetrea exceptionally useful for cases of impending macular holes. There are many patients who have a thin ERM and partial thickness macular hole with only mild vision loss. Jetrea has the potential to remove the ERM and allow the hole to either close or stabilize, thus preserving vision, but without the need for face down positioning required by conventional vitrectomy requiring intraocular gas. This is a viable treatment for certain macular diseases, and best of all, may offer an alternative to the rigors and costs of surgery. All the best, "Randy" Randall V. Wong, M.D. Retina Specialist Capital Eye Consultants www.RetinaEyeDoctor.com |