Jetrea Injection (Ocriplasmin)

vitreous gel
Clear vitreous gel fills the eye (click on image to enlarge)

What is Jetrea® injection used for?

Prior to being discontinued, Jetrea therapy was a treatment for retinal conditions involving abnormal pulling of fibers on the retina. Usually due to ageing, fibers which normally lie on the surface of the retina begin to pull on the retina causing a loss of vision. The treatment involved the injection of medication into the eye to cause of release of traction (pulling) on the retina. It may take weeks to months for Jetrea to take effect.

Jetrea

How effective is Jetrea therapy?

In vitreomacular traction syndrome about 40% of cases improve when the traction is limited. In macular hole cases, successful closure of the hole is seen within six months in as many as 60% of eyes with small holes. Please refer to separate literature on these conditions.

Jetrea VMT
Vitreomacular traction relieved by Jetrea (click to enlarge)

What are the risks of Jetrea therapy?

Severe complications are very rare, but risks of Jetrea injection include bleeding, infection, inflammation, glaucoma, dislocation of lens, retinal detachment, cataract, and loss of vision/loss of the eye. A common side effect of treatment is the appearance of new floaters in the vision. Less than one percent of injections are associated with sudden decreased vision for unknown reasons. Fortunately, the vision returns in most cases within a two week period. About 2% of eyes injected with Jetrea experience a yellow tint in the vision which usually clears with time. Currently, it does not appear that Jetrea has any significant systemic adverse effects.  However, pregnancy should be avoided while on Jetrea therapy.

What do I expect after a Jetrea injection?

If a patch is placed on the eye, keep it on as directed by the doctor, usually 3-4 hours. You may be given eye drops and instructions on how to use them. Physical activity is not limited after the injection. Tylenol or Ibuprofen may be used if there is discomfort, but severe pain should be reported to your doctor without delay. It is normal to experience a red area on the white of the eye, which disappears in one to two weeks. If you have any questions or concerns, please call the office. If Jetrea is not successful, vitrectomy surgery may be considered.

Note: Since June 30, 2020, Jetrea stopped being manufactured.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2013-2020 Designs Unlimited of Florida.  All Rights Reserved.

Macular Hole

globe anatomy
anatomy of the eye (click on image to enlarge)
normal macular OCT
The macula is the center of the retina (in box). The bottom image is an optical coherence tomogram of the macula. (Click to enlarge)

What is a macular hole?

Macular hole means there is a tiny hole in the center of the retina.  The retina is a thin layer of tissue in the back of your eye which lines the inside wall like the film inside the back of a camera.  The retina “takes a picture” of objects you look at and sends it to the brain.  The macula is the center of the retina and gives you sharp central vision for reading and seeing fine details.  When the macula is damaged, the central vision worsens.  Macular hole is not macular degeneration and does not lead to macular degeneration. Macular hole affects both eyes in only about 10% of cases.

What causes a macular hole?

A macular hole is caused when the clear gel that fills the eye (vitreous) pulls on the macula.  When you are born the vitreous gel is thick, clear, and filled with tiny, invisible fibers.  With age or trauma, the vitreous gel begins to condense and pull away from the retina.  If the attachment of the vitreous to the macula is unusually strong, the pulling may result in a macular hole.

What are the symptoms of a macular hole?

Blurring of vision is mild at first, noted especially while trying to read fine print.  It slowly worsens; often with distortion (straight lines look crooked).  Sometimes there is a small blind spot in the center of vision. The visual symptoms may be detected and monitored with the Amsler grid test.

What treatment is available?

In a small number of cases, a macular hole may heal itself. In other cases the vision improves with a medicine injection (Jetrea®). If this fails or is not possible, a surgery may be performed that releases the abnormal pulling of the vitreous on the macula.  A gas bubble (pneumatic retinopexy) is then placed in the eye to close the hole in the macula.  Strict facedown positioning is recommended for several days following surgery.  Special cushions and massage tables are available to help maintain the proper head position.  The most common side effect of surgery is cataract formation.  Cataracts develop after surgery in most eyes over several months to years.  About 5% of eyes require more than one surgery to close the macular hole.  In 2-3% of eyes, the retina may detach during or soon after surgery as a result of continued pulling on the retina by vitreous fibers.  This requires additional surgery to prevent profound loss of vision.  Unommon risks of surgery include hemorrhage, infection, blindness and loss of the eye.

Surgery to close macular hole is usually successful in improving vision, though the vision rarely returns completely to normal.  Some residual distortion and central blurring of vision is common. The vision improves very slowly after surgery over several months to years.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2001-2022 Designs Unlimited of Florida.  All Rights Reserved.

For more information please visit Retina Vitreous Associates of Florida.