Ocriplasmin Chemical Vitrectomy

[21/12/2012]

Ocriplasmin Chemical Vitrectomy

Hello all! It has been too long since my last post as I have been caught up with my work and have not been updating this blog. I have also recently attended a conference and retinal specialists around the world are eagerly awaiting the introduction of yet another new treatment which can potentially change the way we treat our patients!

You may have read in my previous posts where I have mentioned doing a procedure called Vitrectomy to manage certain retinal conditions. This is a very important and effective procedure which is widely used to treat retinal conditions such as retinal detachment, diabetic eye disease, macular holes or membranes, infections and so on.

What is a Vitrectomy?



The name refers to the removal of the vitreous. The vitreous is a clear gel-like structure which fills the back cavity of the eye. It is something that starts out as a gel (when we are born) and undergoes degenerative changes as we age. It is implicated as the source of many diseases whereby the shrinkage and liquefaction of this gel can cause tears in the retina (leading to retinal detachment), abnormal attachments to the macula area can cause macula holes and in diabetics, it serves as a scaffolding for blood vessels to grow onto and subsequently bleeding and scar tissue formation can occur. So removal of the vitreous by doing a vitrectomy is commonly done by retinal specialists to treat these diseases. Vitrectomy is a highly sophisticated procedure which requires a lot of delicate and expensive equipment to perform. Of course, any surgery is also associated with its risks and vitrectomy is no different despite the fact that technology has improved to such a level that the risks are very small. Nevertheless, there has been ongoing research into a better way to remove vitreous and with this latest breakthrough, it is a definite mammoth step in the right direction!

What is Ocriplasmin?

Jetrea
 
In October 2012, this drug was approved by the United States FDA for treatment of symptomatic vitreomacular adhesion. In this condition, there is abnormal attachment between the vitreous and the macular resulting in traction on this area which can present as a distortion or blurring of central vision. In some cases, traction can be severe enough to cause the development of a hole in the macula. Ocriplasmin (or Jetrea as it is commercially known), is a recombinant protease (enzyme) specifically designed to "breakdown" the vitreous. It is delivered as a single injection into the eye and the research studies have shown that it is twice as successful compared to placebo in relieving the traction caused by vitreomacular adhesion and in some cases, closure of macular holes. The findings of this study serve as a significant breakthrough as this will only be the beginning of endless possibilities with further development of this drug or subsequent newer similar drugs. The concept of being able to "do the job" without having to perform invasive surgery such as vitrectomy is of course very appealing. As mentioned previously, despite the relatively small risks associated with vitrectomy surgery nowadays, surgery is still invasive and involves a period of recuperation and "down time" for the patient. Comparatively, a much simpler procedure involving an injection (which is over in seconds) does not incur as much inconvenience and if able to be as effective as surgery, will always be better for the patient. We are of course still a long way away from replacing surgery altogether as vitrectomy is still a vital tool of the retinal surgeon's armamentarium. It is difficult however, not to be excited by the introduction of Ocriplasmin into our "toolbox" as it offers significant benefits over surgery if eventually proven to be as effective as vitrectomy to treat certain retinal conditions. So it is onwards and forwards the retinal community moves and hopefully with further advancements in our field, we will be able to offer more options to our patients with retinal diseases.