Introduction
Jetrea (ocriplasmin) is a recombinant protease enzyme approved for the treatment of symptomatic vitreomacular adhesion (VMA). It represents the first pharmacologic vitreolysis agent that offers a nonsurgical alternative for selected patients with vitreomacular interface disorders.
Mechanism of Action
Ocriplasmin is a recombinant truncated form of human plasmin that cleaves fibronectin, laminin, and collagen, which are components of the vitreoretinal interface. By hydrolyzing these protein components, ocriplasmin induces liquefaction of the vitreous humor and separation at the vitreoretinal interface, thereby releasing vitreomacular adhesion.
Indications
Jetrea is indicated for the treatment of symptomatic vitreomacular adhesion. It may also be effective in cases where VMA is associated with:
- Macular hole (≤400 microns)
- Vitreomacular traction syndrome
- Patients without concomitant epiretinal membrane
Dosage and Administration
- Standard dose: 0.125 mg (0.1 mL of reconstituted solution)
- Administration: Single intravitreal injection into the affected eye
- Preparation: Reconstitute with provided diluent to yield 0.125 mg/0.1 mL solution
- Special populations: No dosage adjustment recommended for renal or hepatic impairment
- Elderly: No specific dosage recommendations (limited data)
Pharmacokinetics
- Absorption: Local ocular administration with minimal systemic exposure
- Distribution: Primarily confined to the vitreous cavity
- Metabolism: Proteolytic degradation in the eye
- Elimination: Systemic elimination half-life approximately 30-60 minutes
- Systemic exposure: Minimal, with plasma concentrations below quantifiable limits in most patients
Contraindications
- Active or suspected ocular or periocular infections
- Advanced glaucoma
- Aphakic patients with rupture of the posterior lens capsule
- Allergy to ocriplasmin or any component of the formulation
- Patients with vitreous hemorrhage that prevents visualization of the retina
Warnings and Precautions
- Retinal breaks and detachment: Reported in clinical trials
- Decreased visual acuity: May occur transiently post-injection
- Dyschromatopsia: Color vision disturbances reported
- Ellipsoid zone changes: OCT changes may occur
- Lens injury: Proper injection technique essential to avoid lens damage
- Intraocular inflammation: Monitor for endophthalmitis symptoms
- Pregnancy: Category C (use only if potential benefit justifies risk)
Drug Interactions
- Antiplatelet/anticoagulant agents: May increase risk of ocular hemorrhage
- Other intravitreal agents: No formal studies; avoid concurrent administration
- Sympathomimetics: Theoretical increased risk of pupillary dilation
Adverse Effects
Most common (≥5%):- Vitreous floaters
- Conjunctival hemorrhage
- Eye pain
- Photopsia
- Blurred vision
- Macular hole
- Visual impairment
- Retinal tears
- Retinal detachment
- Lenticular injury
- Endophthalmitis
- Severe vision loss
- Persistent dyschromatopsia
Monitoring Parameters
- Baseline: Comprehensive ocular examination including:
- Visual acuity assessment - OCT imaging - Intraocular pressure measurement - Retinal examination - Pupillary function
- Post-injection:
- Day 1: Assessment for acute intraocular pressure rise - Week 1: OCT evaluation for adhesion release - Month 1: Comprehensive follow-up examination - Ongoing: Monitor for delayed adverse effects (up to 6 months)
- Special monitoring: Color vision testing if visual symptoms develop
Patient Education
- Report any sudden vision changes, increased eye pain, or sensitivity to light immediately
- Expect temporary visual disturbances including floaters and light flashes
- Understand that multiple procedures may be necessary
- Avoid rubbing or applying pressure to the treated eye
- Use prescribed post-procedure eye drops as directed
- Attend all scheduled follow-up appointments
- Be aware of potential color vision changes and report them promptly
- Understand that vitreous separation typically occurs within 7 days if successful
References
1. Stalmans P, Benz MS, Gandorfer A, et al. Enzymatic vitreolysis with ocriplasmin for vitreomacular traction and macular holes. N Engl J Med. 2012;367(7):606-615. 2. US Food and Drug Administration. Jetrea (ocriplasmin) prescribing information. 2012. 3. Dugel PU, Tolentino M. Ocriplasmin for treatment of vitreomacular traction: an update. Ophthalmol Ther. 2016;5(2):147-159. 4. Kaiser PK, Kampik A, Kuppermann BD, et al. Safety profile of ocriplasmin for the pharmacologic treatment of vitreomacular traction. Retina. 2015;35(6):1111-1127. 5. ClinicalTrials.gov. Microplasmin intravitreal administration for vitreomacular traction. Identifier: NCT00781859.