Jetrea: A New Nonsurgical Alternative for Select Macular Holes and Vitreoretinal Traction Diseases

There is a new in-office nonsurgical treatment available for select conditions involving traction of the vitreous gel on the central retina or macula. The most common ones are macular hole and vitreomacular traction syndrome (more about these in our education tab under macular diseases). These conditions are termed “symptomatic vitreomacular adhesion syndromes” in that there are two main factors: 1) there is active traction of the vitreous gel on the retina, and 2) the traction is resulting in visual symptoms of decreased visual acuity and/or visual distortion.

The treatment is a medication that is injected inside the eye. The medication is called Jetrea (generic name is ocriplasmin) and it is an enzyme that breaks down the connections between the vitreous gel and the retina, relieving the traction from the adhesion. It is injected in the office after drops of anesthesia. The entire procedure lasts seconds and allows the patient to return to normal activities.

Normally, the vitreous gel liquefies as we get older (earlier in near-sighted patients or patients suffering blunt trauma). As it liquefies, the connections between the gel and the retina separate, resulting in a posterior vitreous separation. Typically when this event occurs, patients may experience the onset of floaters and flashing lights. It is during this time that patients are at highest risk for retinal detachment. Normally, the vitreous gel separates, the floaters and flashes subside, and no further problems occur. In a small number of patients, the vitreous gel does not completely separate from the central retina or macular, resulting in decreased vision or distortion.

We typically would monitor these patients for a few months, but the majority would require surgery to relieve the symptoms and improve the vision. If there is also a macular hole, this requires injection of a gas bubble and face down positioning for a week.

In the large clinical trial that led to its FDA approval, Jetrea resolved vitreomacular adhesion in 35% of patients that had a small adhesion without needing surgery. More importantly, in the macular hole patients with vitreomacular adhesion, 41% had closure of the hole with the office procedure and no gas bubble or positioning.

Jetrea is a safe and effective treatment that has provided vision improvement in many patients. More importantly, if Jetrea injection does not help the condition, surgical success rates are not decreased by trying Jetrea.