Ocriplasmin Approved for VMT and Macular Holes

would this be something to trea a psuedo hole in th retina?
Thanks
Jake

Interesting article as always.
I have a question: how can the separation of the vitreous from the retina “cure” PVD?
Can this drug help with the vitreous-retinal re-attachment?
It seems from the way you explain it in the article above that this drug (enzyme) makes a partial detachment complete. But then how do you avoid surgery for reattachment?

testing — not sure what is going on with my posts

when and where world wide will ocriplasmin be available first for doctors to give patients?

Dear Doctor Wong,

I’m 24 years old and have been suffering from floaters in both eyes for 5 years now, with symptoms getting worse (my vision is 20/20 otherwise). At this stage, the condition severely affects my ability to perform well in my job, drive cars, read or enjoy life in general. Eye doctors and a vitreoretinal specialist have suggested that I am too young for FOV given the risk of retinal detachment during surgery, and that I should wait “a few years”.

Would you – after consultation – in principle be able to offer FOV (with or without e.g. Jetrea/ocriplasmin pre-treatment) to someone at my age (24)? If yes, I would contact you to make an appointment. (insurance cover is not a concern for me)

Hi Randy,

I’ll TRY to keep this short despite my complicated case! I appreciate your time and I hope you can answer my questions and possibly perform surgery on me.

1. I’m 42 yrs old and had a retinal tear & hole that was becoming a detachment in August. The episode started with a distinct flashing of light in lower left eye, out of the blue. Five hours later I was in the ER, and while the flashing stopped, every time I moved my eye a huge flash of light would appear in a crescent shape on left side of left eye. The ER doctor told me I was having a PVD, but no retinal detachment.

2. Over the month of August my eye filled with numerous floaters of different opacities, shapes, and sizes. I went back for two follow-ups and was told I had no detachment, despite the fact I absolutely knew something major was wrong. Then on Aug 31 my eye started to flood with hundreds of tiny black specks (in addition to the countless blobs and other larger floaters). I went back to the ER and was told I had a tear that needed immediate surgery.

3. I ended up with a full vitrectomy and scleral buckle on left eye. I am very happy with the surgery in that A) I can at least see with full peripheral 20/300 (i.e. not blind — it could have been much worse), B) I can see 20/25 with glasses (same as before detachment, I had LASIK on both eyes 8 yrs ago). However, the scleral buckle is squishing my left eye (thus resulting in the 20/300 vision), but it is also causing a dull pressure in my left eye & socket & muscles that is difficult to ignore.

QUESTION — Is it possible to loosen a scleral buckle to relieve some of this pressure/dull pain? Is it possible to completely remove the scleral buckle 6-12 months after surgery by assuming retina is fully re-attached and healed? I prefer the latter because I should also get my 20/25 vision back because the left eye will no longer be squished by the buckle. My eye is also very, very dry, probably due to the surgery — do you recommend Restasis?

4. Furthermore, for the past 4 months, my right eye (“good” eye) has been slowly filling with floaters (mostly sheet/blob type floaters, along with one distinct, dark, large floater that is the most problematic). In the past two months, the lower right corner of my right eye “flickers” like a flame almost continuously. It’s usually not quite bright enough to see during the day, but it’s visible at night.. I would say the flickering is present 75% of the time. This is _not_ an immediate onset/offset very bright flash like I had in my left eye; it’s a slowly building “flicker” that usually “on”.

QUESTION: I can literally feel a ‘tugging’ and ‘pinching’ in back of my right eye which I believe is due to VMA traction, would you agree, and would would an OCT scan be in order? The doctors tell me my retina is fine, and I’m probably not having a PVD either. How can this be?? The flickering light in lower right corner of right eye is worrisome to me.

5. My current problem is this: I work in software the combination of the floaters in the right eye (which are not only extremely annoying, but also cause blurred vision) and the dull pain in left eye (which is also blurry because it is so dry) are making it almost impossible for me to work on the computer and earn a living. Probably worse yet is that my driving is becoming impaired for similar reasons. I find that I’m moving my eyes so much during the day to relieve pressure on left eye and move right eye floaters out of the way, that (literally) my eye muscles are sore as if I was lifting weights with them! Something has to be done about this, and my doctor refuses to do a full vitrectomy or FOV. He also claims the Yag Laser floater doctors are quacks in it to make money — I find this ridiculous as I’ve researched the three doctors in US that do it, and I find them very reputable and honest.

QUESTION — This question has been asked 100’s of times before, but in my case where I’ve already had a detachment in the left eye, and my right eye has lattice degeneration (which was ‘reinforced’ by laser during the surgery on my left eye), would you recommend an initial treatment with laser to blast away the largest three floaters in my right eye and then see if I can live with the result? Or would you recommend that I head into your operating room and simply get the vitrectomy done? I would prefer to have a full vitrectomy, and if that means waiting until my right eye has a full PVD then I’m willing to do that. However, I have done a lot of reading on Ocriplasmin (JETREA) and it looks very promising in terms of inducing a PVD to allow a less risky vitrectomy. Does this agent also dissolve the floaters? If so, why not just avoid the surgery all together? Is there another agent in development that dissolves floaters (Vitrase)?

6. What is the recovery time for a floater vitrectomy? Is there a gas bubble involved? It took two weeks for my eye to recover enough after my vitrectomy + scleral buckle before I could see again, and another 1-2 weeks to have my vision stabilize so that I could work again with glasses on. Same deal here?

Thank you very much!
Eric

I’m wondering about the use of this drug in macular hole. Is the main mechanism of this drug inducing PVD? Would you say I would have to be pretty sure the patient did not already have a PVD to expect this drug to be effective for macular hole? Is it thought to release VMT in eyes that already have PVD? Do you know if these distinctions were looked at in studies and could you direct me to the references? THANK YOU!

My mom is in her 60’s, diagnosed with VMT in OD. She already has Corneal Guttae.
She was asked to go thru vitrectomy and removal of cataract together. Is it safe to go thru that or use ocriplasmin. She is in India now, and I can check if ocriplasmin is available there, based on your suggestion. I would really really appreciate your response.

Hello Doctor!

I am 22 yrs. old and having floaters in my both eyes from last 3 years. Just excited to know about vitreolase and vitreosolve to dissolve the floater.

My question is do you about this drug and till how much time it will take to come in the market?

Or there is any new drug for dissolving eye floater in the market is or research is going on ?

pankaj yadav

Dr Wong:

My mother is 82, has macular degeneration in one eye, and has developed vitreomacular adhesion in the other eye. She received a shot of Jetrea 6 weeks ago. 2 week follow-up showed a little improvement, and 4 weeks afterward, again minimal improvement, but the adhesion has not released.

Doctor suggested checking again in 2 weeks, just after the holidays, and said perhaps a 2nd injection should be tried. Everything I read says repeated injections are not recommended, can’t tell if it could be harmful, or just not enough study yet on that scenario. Any experience with this?

We are excited about the prospect of surgery, with her age, and the condition of her other eye, however we may be facing limited options.

thanks so much …..

Dr. Wong,

I was recently diagnosed with a macular pseudo hole in my left eye. (In the same eye, three years ago I had laser surgery to repair a large retinal tear.) It was detected after a slight decrease in vision and via CT scan. The doctor recommends surgery.

I have been unable to find much information about the condition or the surgery. The doctor described it as attempting to pull tape off of something stuck to paper and hoping the paper doesn’t come off with it. Primitive but accurate? Is it a vitrectomy or different? In most cases, can the procedure result in no retinal detachment or gas bubble?

Many thanks in advance.

Face down and for how long after macular hole surgery?