Ocriplasmin
Also known as: Jetrea, Microplasmin, OTX-008, recombinant human plasmin, TSP-64
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Summary
Ocriplasmin (Jetrea) is a recombinant truncated human plasmin administered by intravitreal injection to treat symptomatic vitreomacular adhesion (sVMA) and vitreomacular traction (VMT). By enzymatically cleaving proteins that hold the vitreous to the macula, it aims to induce posterior vitreous detachment, resolve adhesion, close small macular holes, and reduce the need for surgical vitrectomy.
Mechanism of Action
Ocriplasmin is a serine protease that targets extracellular matrix proteins (e.g., fibronectin, laminin) at the vitreoretinal interface. Its proteolytic activity weakens the adhesive bonds between the posterior vitreous cortex and the macular surface, promoting a pharmacologic posterior vitreous detachment and allowing the retina to re‑attach without surgical intervention.
What the Research Shows
Four randomized controlled trials (total 932 eyes) compared a single intravitreal 125 µg ocriplasmin injection with sham or placebo. High‑certainty evidence showed a three‑fold increase in VMA release within 28 days (RR 3.46) and higher macular‑hole closure (RR 2.87). Moderate‑certainty data indicated greater ≥3‑line visual‑acuity gain at six months (RR 1.95) and a 33 % reduction in vitrectomy rates (RR 0.67). Real‑world studies (2402 patients) reported comparable VMA‑resolution and macular‑hole closure rates, with a higher odds of non‑surgical VMA resolution but variable safety reporting. Long‑term safety data remain limited.
Reported Benefits
Evidence from RCTs demonstrates that ocriplasmin significantly increases the likelihood of VMA release, achieves macular‑hole closure, and promotes complete posterior vitreous detachment within weeks. Patients are more likely to experience meaningful visual‑acuity improvement and are less likely to require subsequent vitrectomy, offering a non‑surgical alternative for selected eyes.
Limitations of the Evidence
Up to 20 % of treated eyes still need vitrectomy within six months, and success is lower in eyes with epiretinal membrane or broad adhesions. Adverse ocular events are more frequent than with control injections. Long‑term safety data are sparse, and real‑world reports show inconsistent documentation of complications. Careful patient selection is essential for optimal outcomes.
Safety Considerations
Moderate‑certainty evidence indicates a higher overall ocular adverse‑event rate with ocriplasmin (RR 1.22). Common events include vitreous floaters, photopsia, photophobia, new or worsening subretinal fluid, and transient electroretinogram changes. Most are related to posterior vitreous detachment, but the clinical significance varies, and long‑term safety remains incompletely characterized.
How It Is Administered
Ocriplasmin is delivered as a single intravitreal injection of 125 µg (0.1 mL) of recombinant protein. The formulation is supplied in a sterile vial for ocular use and is injected directly into the vitreous cavity under aseptic conditions.
Routes of Administration
Goals & Uses
- Macular hole closureOphthalmologyHigh
- Pharmacologic vitreolysisOphthalmic / VitreoretinalHigh
- Resolution of symptomatic vitreomacular adhesion (VMA)Ophthalmic / VitreoretinalHigh
- Vitreomacular adhesion releaseOphthalmologyHigh
- Non-surgical closure of macular holes ≤400 µmOphthalmic / VitreoretinalHigh
Contraindications
- Severe retinal detachmentRetinal PathologyHigh
- History of rhegmatogenous retinal detachmentOcular ConditionHigh
- Recent intraocular surgery (<30 days)Surgical HistoryModerate
- Known hypersensitivity to ocriplasmin or excipientsAllergyHigh
- Large macular holes (>400 µm)AnatomicalHigh
- Exudative age-related macular degenerationOcular ConditionModerate
- Active intraocular infectionOcular InfectionHigh
- Proliferative diabetic retinopathyOcular ConditionHigh
- High myopia (axial length >26 mm or refractive error > -8 diopters)Ocular ConditionModerate
Adverse Effects
- Transient decreased visual acuityOcularCommon
- Retinal detachmentOcularUncommon
- Cataract progressionLensRare
- Intraocular inflammation (uveitis)InflammatoryRare
- Dyschromatopsia (color vision changes)OcularUncommon
- Photopsia (flashes of light)OcularCommon
- Retinal tear or detachmentRetinalUncommon
- Transient visual lossVisualCommon
- Macular hole enlargementOcularUncommon
- Vitreous floatersOcularCommon
- Photopsia (flashing lights)VisualCommon
Drug Interactions
- Intravitreal anti‑VEGF agents (e.g., ranibizumab, aflibercept)Moderate
- Anti-VEGF agents (e.g., ranibizumab, bevacizumab)Low
- Intravitreal steroids (e.g., triamcinolone)Low
Population Constraints
- PregnancyReproductive SafetyRelative
- Pediatric patients (<18 years)AgeAbsolute
- Pediatric patientsAgeRelative
- Patients with lens zonule weaknessOcular ConditionRelative
- Pregnant womenReproductiveRelative
Regulatory Status
- European UnionApprovedApproved: symptomatic vitreomacular adhesionEMA approval (2013) with restricted use; post‑marketing surveillance ongoing.
- United StatesApprovedApproved: symptomatic vitreomacular adhesionApproved by FDA (2012). Label includes boxed warning for vision loss.
- United KingdomApprovedApproved: symptomatic vitreomacular adhesionAvailable under NHS with specialist prescription.
FDA approved in 2012 (US) and EMA approved in 2013 (EU). Post‑marketing safety concerns have led to restricted labeling and limited use, but the drug remains approved.
Evidence & Sources
- Journal ArticleHighNeffendorf JE, et al.2017-01-01T00:00:00.000000Z
- Journal ArticleModerateShao L, Wei W2014-01-01T00:00:00.000000Z
- Journal ArticleModerateKhan MA, Haller JA2015-01-01T00:00:00.000000Z
- Journal ArticleHighKhanani AM, et al.2021-01-01T00:00:00.000000Z
- Journal ArticleModerateWan R, et al.2018-01-01T00:00:00.000000Z
- Journal ArticleModerateJackson TL, et al.2013-01-01T00:00:00.000000Z
Frequently Asked Questions
What condition does ocriplasmin treat?
It is used for symptomatic vitreomacular adhesion and vitreomacular traction, conditions where the vitreous remains abnormally attached to the macula and threatens vision.
How does ocriplasmin differ from surgery?
Unlike pars plana vitrectomy, ocriplasmin works pharmacologically to dissolve the protein bonds at the vitreoretinal interface, potentially avoiding an invasive surgical procedure.
Is ocriplasmin effective for all patients?
Effectiveness is higher in eyes without epiretinal membrane and with focal adhesions. About 20 % of treated eyes still require surgery, so patient selection influences success.
What side effects should be expected?
Patients may experience transient floaters, flashes of light, photophobia, or sub‑retinal fluid. These events are generally related to vitreous detachment and are more common than with placebo.
How long does the benefit last?
Clinical trials report outcomes up to six months, showing sustained visual improvement and reduced need for vitrectomy, but longer‑term data are limited.
What is Ocriplasmin?
Ocriplasmin (Jetrea) is a recombinant truncated human plasmin administered by intravitreal injection to treat symptomatic vitreomacular adhesion (sVMA) and vitreomacular traction (VMT). By enzymatically cleaving proteins that hold the vitreous to the macula, it aims to induce posterior vitreous detachment, resolve adhesion, close small macular holes, and reduce the need for surgical vitrectomy.
What is Ocriplasmin used for?
Ocriplasmin is educationally associated with: Macular hole closure, Pharmacologic vitreolysis, Resolution of symptomatic vitreomacular adhesion (VMA), Vitreomacular adhesion release, Non-surgical closure of macular holes ≤400 µm. Educational only — not medical advice.
How is Ocriplasmin administered?
Recorded routes of administration: Intravitreal.
What are the potential side effects of Ocriplasmin?
Reported adverse effects include: Transient decreased visual acuity, Retinal detachment, Cataract progression, Intraocular inflammation (uveitis), Dyschromatopsia (color vision changes), Photopsia (flashes of light), Retinal tear or detachment, Transient visual loss, Macular hole enlargement, Vitreous floaters, Photopsia (flashing lights). This list is not exhaustive — consult a qualified clinician.
Who should avoid Ocriplasmin?
Recorded contraindications: Severe retinal detachment, History of rhegmatogenous retinal detachment, Recent intraocular surgery (<30 days), Known hypersensitivity to ocriplasmin or excipients, Large macular holes (>400 µm), Exudative age-related macular degeneration, Active intraocular infection, Proliferative diabetic retinopathy, High myopia (axial length >26 mm or refractive error > -8 diopters). Consult a qualified clinician before use.