23 Feb New Drug Induces Posterior Vitreous Detachment (PVD)
A new drug, Ocriplasmin, is seeking FDA approval for treatment of some retinal disorders. Ocriplasmin (also known as microplasmin) may help patients with vitreomacular traction syndrome (VMT) and macular hole by chemically inducing a PVD.
The drug may gain Priority Review status by FDA later this year. Priority Review is a special designation for drugs that show either a significant improvement over existing therapies, or where there is not current therapy.
VMT and macular hole are two similar conditions where vitreous remains adherent to the macula causing pulling and stretching of the macular area. This physically disrupts the macula causing decreased vision and /or distortion.
Current therapy includes surgery to separate the vitreous from the underlying retinal tissue. Ocriplasmin may achieve the same goal by chemically separating this interface.
The drug has been given by intravitreal injection.
Posterior Vitreous Detachment (PVD)
The excitement in the retinal field stems from the fact that so many retinal diseases are caused by the vitreous. Many macular disorders are probably caused by interaction between the macula (retina) and the adherent vitreous.
Currently, the vitreous separates from the retina either naturally as we get older or it is induced surgically.
As we age, the vitreous proteins degenerate as does the “glue” keeping the vitreous adherent to the retina. At some point in everyone’s life a posterior vitreous detachment naturally occurs. At the time of a PVD, there is a naturally increased risk of sustaining a retinal tear. Retinal tears may develop into retinal detachments.
During surgery for many retinal diseases, surgical induction of a PVD is often helpful to achieve the surgical goal. There are, however, potential complications from pulling the vitreous away from the retina. There is a greater chance of surgically causing retinal tears!
What Does This Mean?
Chemical induction of a PVD would be a great alternative to surgery. In theory, the chance of retinal tear is greatly reduced by avoiding surgery. Hence, it is an attractive and potentially safer alternative compared to surgery because the complications may be fewer.
Just as important, however, is whether the new treatment is as effective as the current treatment. In other words, will simply injecting the new drug improve patient results as compared to surgical techniques.
If the drug gets approved by the FDA, it will be “approved” for VMT/macular holes. Once on the market, however, it will be likely be adopted for use in many other retinal conditions.
Used as an adjunct to surgery, the complication rate of retinal tears might be decreased making “surgery” much safer.
AlPosted at 07:29h, 24 February
Dear Doctor Wong,
do you think, that this new drug can also be helpful for floater vitrectomy ??
Is it useful here and can it reduce some risks here ?
Randall V. Wong, M.D.Posted at 21:58h, 24 February
Tough question. I struggled with adding a bit about that toward the end of the article. Not sure there is really a place for the new drug. One thing that is not clear is how long the PVD will take to occur. It may take at least 3-4 weeks and only in some of the patients…not sure that I’d consider this a “slam-dunk” yet.
On the other hand, if you have VMT/macular hole….that’s a different story…not dealing with a normal eye and in eyes with reduced vision.
This is why we must also question how effective the drug may be.
LeePosted at 18:15h, 26 February
Dear Dr. Randall,
I keep reading about how inducing a PVD would help patients with floaters. Can you tell me why?
Randall V. Wong, M.D.Posted at 17:24h, 28 February
There is a fear that if a PVD is NOT induced at the time of surgery then when a PVD naturally occurs later in life, the floaters will return.
Not sure if this is really true. Consider everyone gets a PVD as we age. It is a natural event. Very few people have issues with floaters.
Also, no telling when a PVD will occur. If you are young and have issues with floaters, it may be decades before a PVD occurs naturally.
Hope this was somewhat helpful.
harmPosted at 16:25h, 31 March
Dear dr Wong,
Many young people have floaters that are located very close to the retina that can hardly be seen by doctors because theya re too small, but appear big to the patients. Do you know if inducing a PVD or a natually occuring PVD may get rid of those floaters when the distance to the retina gets bigger?
Randall V. Wong, M.D.Posted at 06:41h, 04 April
Inducing a PVD would indeed remove any floaters close to the retina. I don’t think that’s the problem. Most, if not all, floaters/vitreous can be safely removed by getting close enough to the retina and NOT inducing a PVD.
Remember, too, doctors/examiners can NOT see all the floaters visible to a patient, or rather, we (docs) can NOT always determine which floaters are problematic – your vitreous is supposed to be transparent to you, yet completely visible to me.
Hope this was more helpful than confusing.
JoshPosted at 21:19h, 10 April
How about inducing PVD to reduce risk of PDR? Remove the “scaffolding” for neovasculation and add oxygen all at once?
PetePosted at 15:51h, 11 April
Hi dr Wong,
Do you think this drug could already help floater patients without performing a FOV? or would FOV still be needed after inducing PVD?
Randall V. Wong, M.D.Posted at 11:39h, 20 April
That was my point in writing about this. There is the potential that this drug may obviate the need to surgically “induce” a PVD, but I don’t think it will obviate the need for surgery. It may simply chemically cause a PVD versus physically separating the vitreous from the retina.
Ken EPosted at 13:28h, 22 April
Thanks Dr. Wong. I’ve been following this developing story and feel good that you are too. I had a vitrectomy in one of my eyes several months ago following PVD that caused a tear. My doc repaired the tear and then several months later performed the vitrectomy to remove all the floaters and debris caused by PVD. I now have tons of floaters in my other eye but I don’t think that I have had PVD yet as the floaters are different than my other eye, however, the sheer volume is exponential. Reading your comment above, are you implying that a vitrectomy to remove floaters can be done successfully on a patient who has not yet had PVD and without inducing PVD? I’ll add that I’m not “young” being just over 50. I don’t like what I hear about how the induced PVD process involves if I understand it correctly as it sounds like there is a potential for both short- and long-term risks. Thanks for all the valuable info you put onyour sires and for participating in these comments.
Randall V. Wong, M.D.Posted at 18:38h, 23 April
Yes, I feel strongly that a vitrectomy can be done to successfully remove the floaters that are bothering you without inducing a PVD.
I do not induce a PVD in this situation and do not feel it is necessary.
Ken EPosted at 20:03h, 02 May
Do you have any additional info about non-PVD induced vitrectomies? I went in for my follow up and my doc wasn’t interested in discussing a PVD induced or a non-PVD induced vitrectomy. He said just wait but who knows, I could wait 5-10 years for my PVD. Thanks Dr. Wong.
Randall V. Wong, M.D.Posted at 12:08h, 03 May
I don’t feel that non-PVD vitrectomies are bad. I think removing most of the vitreous, but not specifically inducing a PVD probably;
1. Decreases the likelihood of dense floaters when the PVD eventually, and naturally, occurs.
2. Prolongs onset of the PVD, that is, it may occur later in life as there is less inertia from the central “core” vitreous to naturally induce the PVD.
Ken EPosted at 15:54h, 04 May
Ok, one more and I’ll leave you alone on this subject. What about frill? My doc (appropriately) left vitreous against and near the lens, however, I guess there is no way to determine what the patient may see. I have a somewhat bothersome area from frill. In doing a core FOV, would the patient be subject to frill around the entire eye? Did I ask that correctly? It would be fantastic to be rid of my floaters but not as a trade off to frill. Thanks a million.
Randall V. Wong, M.D.Posted at 13:25h, 13 May
Believe it or not, I’ve never heard of “frill.” Is it the interface between “cut” vitreous and fluid?
Usually it doesn’t impact or create much change in the vision.
Wouldn’t be terribly concerned.
Ken EPosted at 14:37h, 15 May
The frill I’m referring to is the edge of the vitreous left after a vitrectomy to preserve the lense. I see a type of flapping in the very upper right part of my periphery. If vitreous is left around the entire circumference of the eye during a core vitrectomy, does the vitreous left behind become visible? thanks Dr. Wong
Randall V. Wong, M.D.Posted at 13:32h, 22 May
Dear Ken E,
No I doubt it would be visible. It is possible that there was/is some opacity/large floater left in the remaining “frill’ and that’s what you are seeing and not the “edge.”
David LeePosted at 15:35h, 26 May
Hello there….. I to had a induced PVD……
Had a follow up with my surgeon, he said he cant see this frill/ wavy dark line I see to the far right of my fov’ed eye…..
he did say it wasent anything serious like a retinal tear ect so it must either be a strand of lose vitreous or where the surgeons stopped cutting….
I just wonderd could a core fov help this?
Randall V. Wong, M.D.Posted at 15:19h, 04 June
FOV is the same as core vitrectomy….or at least in the world according to Wong!
The vitrectomy operation is the same as a “core” vitrectomy. When performed to remove floaters, it is called FOV.
SubirPosted at 17:48h, 16 June
thanks for the article. Like many males in their 20s, I have a floater very close to my retina in the “bursa premacularis” area, and I think chemically inducing PVD may make the shadow on my retina much smaller by just moving the floater a few millimeters further away without having to go through the additional problem of FOV.
Do you think my suspicion could be right, Dr. Wong?
Randall V. Wong, M.D.Posted at 10:39h, 18 June
Yes. Possible, but also many not be helpful as there is no way to predict if there will be a change in the location of the floater upon PVD.
There are risks of the injection vs. risks of an operation.
Ken EPosted at 08:23h, 27 July
FDA approved Ocriplasmin.
Randall V. Wong, M.D.Posted at 11:24h, 31 July
Thanks for keeping up to date!
JochemPosted at 09:26h, 22 October
For those interested: FDA approves ocriplasmin: November 18
I hope it will be of any use in the treatment of floaters by inducing PVD so that the floaters move away from the retina or just to make vitrectomy easier.
Randall V. Wong, M.D.Posted at 07:25h, 24 October
This indeed may be helpful. Remember, when a PVD “naturally” occurs, there is a chance of a retinal tear. Who knows if this is true with a chemically induced PVD?
Also, I would like to find out the risk of infection of the actual injection vs. risks of vitrectomy.
NDPosted at 14:24h, 26 October
Hi Dr Wong
I am just 29 and have been diagnosed today with a PVD in my Right eye where i had a retinal tear 10 years back. Could you point out complications of PVD at such a young age and how the new drug might help.
Randall V. Wong, M.D.Posted at 12:10h, 30 October
29 years is pretty young for a PVD. In a way, however, it is a good thing. The vitreous only causes problems in the eye…such as a retinal tear. I don’t know any long term complications that might occur from a long-standing pvd.
The new drug, in my opinion, won’t help. It is only good a creating a PVD…which you already have.
NDPosted at 14:52h, 26 October
Sorry for asking one more question…just taking time to collect my thoughts…wouldnt this drug could help prevent ‘epiretinal membrane’…since the seperation of vitreous from retina would be induced and (probably) controlled !
Randall V. Wong, M.D.Posted at 12:11h, 30 October
Good thought, but in my experience, PVD is the start or instigating factor leading to the development of ERM.
In most of patients with ERM, a PVD is already present.
Pingback:Ocriplasmin Approved for VMT and Macular HolePosted at 11:37h, 31 October
[…] Ocriplasmin, or Jetrea, has been FDA approved. The drug is approved only for a retinal condition called vitreomacular traction (VMT) or vitreomacular adhesion (VMA). The VMT may or may not be associated with a macular hole. […]
Freddie MaxwellPosted at 11:52h, 02 September
Hello Dr, Wong
I have what my eye Doc calls Weiss ring floaters, I have them in both eyes and it’s been over a year and a half since the onset. They have dropped a little bit, but now they are right in my field of vision, My retinologist seems to think they might still settle to the bottom with time, but I have my doubts at this point. Do you think I may have a full PVD or maybe a partial one that is still keeping the virus from fully separating from the retina? I’m experiencing flashes in my left eye which my ophthalmologist believes virus gel is still tugging on the retina. These rings have what appears to be a tail at the end, is this tail whats attached to the retina and keeping the natural gravity from letting them drop…Or am I just making an untrained guess…My question is, will this drug help in allowing these Weiss rings drop out of my field of vision and eventually drop to the bottom?, or is a FOV the only option (which my retinologist refuses to preform because of the risks involved) This condition is very debilitating and my quality of life has diminished to the point that I almost had a successful suicide attempt last fall where I ended up in the ICU for 15 days. Very bad situation, but that’s another story. I am willing to try anything no matter the risks to make them go away. Thanks for taking the time to read this…Freddie
Randall V. Wong, M.D.Posted at 14:41h, 08 October
Apologize for the long delay.
You undoubtedly have a PVD. No real such thing as partial.
Jetrea may do nothing at all as it is designed to chemically induce a PVD. But you already have one (or two).
Vitrectomy (25 gauge) is safer than cataract surgery with regards to infection and/or retinal detachment. Your retinologist may not understand this nor perform using 25 gauge.
If you had one choice to definitively remove the floaters…vitrectomy (FOV).
Hope this was helpful and, again, sorry for the long delay in responding.
Randall V. Wong, M.D.
Fairfax, VA 22030
cathy seeman gajdosPosted at 09:18h, 07 January
hi I having been dealing with a Weiss ring for 5 years I was 21 with a retinal detachment then 30 years later a retinal tear I am 58 years old I have gone to several retina specialist all they say is there is nothing they can do but just recently I went to a retina doctor in Pittsburgh dr verstada he said to come back in 6 months he was talking about this drug. I also have cataracts, astigmatisms, the light are unbearable I have to follow up in February to my optholmoligists to see if the cataract which has the Weiss ring is ready. my question like the gentleman up above will the surgery help with this Weiss ring or the retina doctor who said to come back? thank you cathy gajdos
Randall V. Wong, M.D.Posted at 16:08h, 21 January
Vitrectomy surgery, or FOV, should remove the Weiss ring without any difficulty.
The new drug, Ocriplasmin, won’t necessarily be useful in those with a PVD and Weiss ring; it may not help at all (likely, as the drug simply chemically induces a PVD – by definition, you’ve already got a PVD as there is a visible Weiss ring) or make your floaters more noticeable.
I’ve got a new site for floater sufferers. Please visit and subscribe?
Thanks and all the best!
Randall V. Wong, M.D.
Fairfax, VA. 22030