Ocriplasmin (Jetrea): What Happened to the Injection for Vitreomacular Traction
Ocriplasmin at a Glance: The Eye Drug That Was Meant to Replace Surgery
Ocriplasmin, sold as Jetrea, was a one-time shot into the eye. The idea was simple. Free the gel that tugs on the center of your retina, and skip an operation. The drug is no longer made. Retina specialists writing about current practice report that the maker has stopped production1. In Europe, the licence was formally withdrawn on 30 August 2023, at the company's own request, for business reasons2.
So there is no drug left to ask for. There is still a plan for you. Most eyes are watched first. Surgery is there if the pull does not let go.
The inside of your eye is filled with a clear gel called the vitreous. With age, that gel shrinks and peels away from the retina. In vitreomacular traction, part of the gel stays stuck to the macula, the small central patch of retina you read with, and tugs on it, so straight lines can look wavy or bent and central vision can blur3. The short forms in your chart are VMT for the traction and VMA for the adhesion behind it.
This is a mechanical problem, not an infection and not a growth. That is why the fixes were only ever time, an enzyme, or surgery.
If someone told you years ago that a shot could avoid surgery, they were describing a real option that has since gone away. Nothing has replaced it as a direct swap. In current practice, adhesion without symptoms is usually observed, and vitrectomy is the standard operation when surgery is chosen1.
Bring your old records. Your doctor measures the pull on a scan called optical coherence tomography (clinical: OCT, a cross-section of the retina made with light), then decides the next step with you.
What Ocriplasmin Is and How One Injection Was Meant to Work
Ocriplasmin is a shortened, laboratory-grown version of plasmin, a protein-cutting enzyme your own body already makes. It was grown in yeast cells rather than taken from human blood. The brand name in the United States and Europe was Jetrea.
It was authorised in the European Union on 13 March 2013 for vitreomacular traction in adults, including cases with a macular hole of 400 microns or less2. In the United States the licensed use was symptomatic vitreomacular adhesion, with approval in October 20124.
The gel is anchored to the retina by protein fibers. Ocriplasmin was designed to snip those fibers chemically, so the gel would separate on its own without a surgeon entering the eye. That is why the approach was called enzymatic vitreolysis (clinical: dissolving the vitreous attachment with an enzyme).
The appeal was real: one office visit, one injection, no operating room. The catch, measured later in trials, was that the enzyme worked in a minority of eyes.
The alternative was and still is pars plana vitrectomy, an operation that removes the gel through small ports in the wall of the eye. Retina specialists treat it as the standard operation, and eyes often gain two or more lines of vision on the eye chart1. It is still surgery, with a recovery and a trade-off for your natural lens.
An injection promised to skip all of that. Reviewers later found that ocriplasmin probably lowered the number of people who went on to vitrectomy, by roughly 87 fewer operations for every 1,000 eyes treated at six months5. Helpful, but far from a replacement for surgery.
How the Injection Was Given and What the Following Weeks Looked Like
This describes how the drug was used when it existed. It is background, not instructions. The United States label set a single 0.125 mg injection into the vitreous gel of the affected eye, and it did not recommend giving a repeat injection in the same eye4.
One eye was treated at a time. A retina specialist made the decision after an OCT scan, never on symptoms alone.
The visit looked like any other injection into the eye: numbing drops, a cleaning solution, a small lid holder, then a few seconds for the injection. Most people described pressure rather than pain.
Patients went home the same day with a warning list. Floaters, red patches on the white of the eye, eye pain, flashes of light, and blurred vision were among the reactions reported in the trials4. Most of these settled over days.
Success was measured on a scan, not on how you felt in the first week. In the pivotal trials the check point was day 28, when the scan showed whether the adhesion had released6. If it had not released by then, a second dose was not the answer, and the conversation turned to surgery or continued watching.
Vision lagged behind the scan. A retina tented for months takes time to settle, so doctors kept measuring for six months.
What the Trials Actually Showed About Ocriplasmin
This is the number that decided the drug's fate. In the two pivotal placebo-controlled trials, the adhesion resolved by day 28 in about 27 of every 100 eyes given ocriplasmin, compared with about 10 of every 100 eyes given a placebo injection6. So roughly 17 extra eyes in every 100 got a release they would not otherwise have had.
Put the other way, about 73 of every 100 treated eyes did not release at 28 days. That is a real benefit sitting inside a lot of disappointment.
Avoiding surgery was the whole point, so reviewers measured it directly. Across four randomised trials in 932 eyes, ocriplasmin released the adhesion more often than control and probably reduced vitrectomy at six months by about 87 fewer operations for every 1,000 eyes treated, while adding about 106 more adverse events for every 1,000 eyes treated5. The review rated the surgery finding moderate certainty.
In plain terms, about one in five people treated with ocriplasmin still went on to have surgery later5. The injection changed the odds. It did not take the operation off the table.
Several things stacked up at once. Commentators pointed to release rates well below what vitrectomy achieves, difficulty pinning down which patients would respond, roughly 30 of every 100 cases settling on their own, and a 2017 survey in which only about 6 of every 100 vitreoretinal surgeons said they would choose the drug first7.
Surgery also got better over the same years. A modest injection competes poorly against a dependable operation and against simply waiting.
Side Effects and Safety Signals Reported With Ocriplasmin
Most reported effects were short-lived and expected after any injection into the eye. The label listed floaters, bleeding under the surface membrane of the eye, eye pain, flashes of light, blurred vision, reduced sharpness of vision, and swelling in the retina among reactions in the treated group4.
None of that means something went wrong. People still needed a clear list of what could wait and what needed a call.
The uncomfortable part of the safety record was an early dip in sight. In the controlled trials, best-corrected vision fell by three lines or more during the first week in about 6 of every 100 treated eyes, compared with about 3 of every 100 eyes given the inactive vehicle4. That risk was the reason people were checked soon after the injection rather than left to wait.
If you were treated years ago and remember a bad week, that is documented rather than imagined. Any lasting change still deserves a current eye exam.
A smaller group of effects worried doctors most. About 2 of every 100 people injected reported a yellowish shift in color vision, and in roughly half of those the retina's electrical test also changed4. The label also carried reports of the lens shifting position, seen in animal studies and in one premature infant given more than the labeled dose4.
Retinal tears and detachments were recorded in both the treated and the untreated trial groups4. That is why any injection into the eye is followed by a prompt dilated exam if new floaters or flashes appear.
Who Was Told to Wait On or Skip This Injection
Selection turned out to matter more than anyone first expected. In a pooled analysis of 274 treated patients, the adhesion released by day 28 in 65 of 93 people younger than 65 years, compared with 89 of 181 people aged 65 or older, and in 137 of 230 eyes with no epiretinal membrane, compared with 12 of 38 eyes that had one8.
An epiretinal membrane is a fine scar sheet on the retinal surface. When one was present, many specialists went straight to a surgical discussion instead.
The licence set the outer edge of who could be treated at all. In Europe it covered adults with vitreomacular traction, including cases with a macular hole of 400 microns or less2. In the United States the licensed use was symptomatic vitreomacular adhesion4. Outside those descriptions, there was no approved use.
Everything else was a judgment call made in the exam room, with your scan, your other eye conditions, and your allergy history in front of the doctor. Nothing on a web page can make that call for you.
People whose scan showed no change often asked for another try. The label did not recommend repeat injection into the same eye4, and the trial evidence gave no reason to expect a different result the second time.
That is why the drug felt like a single roll of the dice. Either the pull let go within about a month, or you moved on.
Your Realistic Outlook for Vitreomacular Traction Today
Time is a genuine treatment here, not a consolation prize. Roughly 30 of every 100 cases settle on their own, which is one reason the drug struggled to show its worth7. Mild traction that is not troubling your vision is commonly watched with follow-up visits rather than treated3.
Watching is not doing nothing. It means scheduled scans, a home vision check, and a clear agreement about what would change the plan.
Most decisions come down to a short list. Where you land depends on how much your vision bothers you and what the scan shows.
| Path | What it involves | Main trade-off |
|---|---|---|
| Watching | Scans every few months, home vision checks | No procedure risk, but symptoms can persist |
| Vitrectomy | Day surgery removing the gel through small ports | Dependable release, but surgical risk and faster cataract |
| Gas injection | Office injection of an expanding gas bubble | Less studied, and retinal tears are a real concern |
Specialists describing current practice observe adhesion without symptoms, treat vitrectomy as the standard operation, and use the office gas injection cautiously because retinal tears happen often enough to matter1.
Distortion is tiring in a way a vision chart does not capture. Reading a menu can feel effortful while one eye sends a warped picture. Covering that eye briefly often confirms which one is at fault.
Tell your doctor how the distortion affects your daily life, not just what you can read on the chart. That is what moves a case from watching toward surgery, and only you have it.
Warning Signs Worth a Same-Day Call to Your Eye Doctor
Vitreomacular traction itself changes slowly, so a sudden change usually means something else. Call your eye doctor the same day, or use an emergency room if your practice is closed, for any of these:
- A sudden shower of new floaters, or a burst of flashing lights
- A dark curtain or shadow moving across part of your sight
- Sudden loss of vision, or a sudden sharp drop in one eye
- Severe eye pain, or a red and painful eye with light sensitivity
Most of these calls end in reassurance after a dilated exam. The reason to call anyway is that among people who arrive with new flashes and floaters, a retinal tear is found in roughly 8 to 10 of every 1009, and a retinal detachment is repaired with surgery, with vision still improving for weeks to months afterwards10.
Other changes matter but are not emergencies. Book a normal appointment if your distortion clearly worsens over weeks, if a small blank patch appears in the middle of your vision, or if reading gets noticeably harder.
Note when it changed. A dated description helps your doctor separate a slow drift from a real step down.
Vitreomacular traction is a retina problem, so the person you want is a retina specialist. An optometrist or general ophthalmologist can start the workup, refer you, and do follow-up scans between visits.
There is no single correct interval. It follows your scan and your symptoms, and it is a fair question to ask at each visit.
Common Questions About Ocriplasmin and Jetrea
Not through normal channels. Production has been discontinued by the manufacturer1, and the European authorisation was withdrawn on 30 August 2023 at the company's request for commercial reasons2. That means no pharmacy stock, no supply chain, and no plan to restart. If a clinic offers you something described as an equivalent injection, ask exactly what the product is and what the evidence for it looks like.
The recorded reason was commercial rather than a safety recall. The European withdrawal was requested by the licence holder for commercial reasons2. Safety questions did exist, particularly early vision drops and color-vision changes, and they made doctors cautious. What finished the drug was that too few eyes responded to justify the cost and the caution, so it was used less and less.
If your vision has been stable since, there is nothing special to chase. If you have noticed a lasting change in sharpness or color since the injection, mention it at your next exam, because color-vision shifts and retinal electrical changes were reported in a small share of treated people4. Any sudden new floaters, flashes, or a shadow still deserve a same-day call, whatever your history.
Better than a placebo, and well short of surgery. The adhesion resolved by day 28 in about 27 of every 100 treated eyes versus about 10 of every 100 given placebo6. Pooled across four trials, it also cut vitrectomy by roughly 87 operations for every 1,000 eyes treated5. Useful, real, and not the surgery-free answer people had hoped for.
Many retina specialists rarely used it. In a 2017 survey, only about 6 of every 100 vitreoretinal surgeons said they would choose it first7. Eyes with an epiretinal membrane, and eyes of people aged 65 or older, responded much less often8, which ruled out a large share of people with the condition. Your doctor may have judged that your scan predicted a poor response.
Nothing has taken its place as a licensed injection for this condition. The alternatives your specialist will discuss are observation, an office gas injection in selected cases, and vitrectomy. Practice reviews describe vitrectomy as the standard operation when surgery is chosen1. If you are offered something new, ask whether it is part of a study and what happens if it does not work.
More Questions About Treating Vitreomacular Traction Today
Waiting is a monitored plan, not a gamble taken blind. Mild traction that is not affecting vision is commonly watched with follow-up visits3, and roughly 30 of every 100 cases settle on their own7. The thing your doctor watches for is a full-thickness macular hole. That is why the schedule of scans, and your own home vision check, are part of the plan rather than optional extras.
It removes the pull dependably, but your retina decides how much vision returns. Eyes often gain two or more lines on the eye chart after surgery1, and some distortion can remain, especially when the traction has been present a long time. Recovery is measured over months. Ask your surgeon for a range based on your own scan and symptom history, rather than a single promised result.
If you still have your natural lens, it tends to cloud sooner after vitrectomy. In one cohort, nuclear cataract progressed slowly after vitrectomy in people under 50 and appeared to progress several times faster in people older than that11. Your surgeon should raise this before you agree. Cataract surgery is routine and usually done later as a separate procedure. If you have already had it, this trade-off does not apply.
Test each eye separately, once a day or as your doctor advises, by covering one eye and looking at a straight line such as a door frame or an Amsler grid. Note anything new: more bending, a growing blur, or a blank spot. A change that is new and clearly worse is worth a call rather than a wait. Your eye clinic can usually give you a grid to print.
Bring a written list. These are the questions that tend to change what happens next:
- What does my scan show about how much the gel is pulling, and has it changed since last time?
- Do I have an epiretinal membrane as well, and does that change my options?
- If we watch, how often will I be scanned, and what finding would make you recommend surgery?
- What are the specific risks of vitrectomy for my eye, given my age and lens status?
- What symptoms should make me call you the same day rather than wait for my appointment?
- Who do I call after hours, and where should I go if your office is closed?
- Review of Ophthalmology, retina specialist practice review (2024). Vitreomacular Traction: Observe or Operate?.
- European Medicines Agency (2023). Jetrea (ocriplasmin): European public assessment report, authorisation withdrawn.
- American Academy of Ophthalmology (EyeSmart) (2024). What Is Vitreomacular Traction?.
- US Food and Drug Administration (2017). JETREA (ocriplasmin) Intravitreal Injection, US Prescribing Information, BLA 125422/S-038.
- Cochrane Database of Systematic Reviews, Neffendorf et al. (2017). Ocriplasmin for symptomatic vitreomacular adhesion (Cochrane systematic review).
- New England Journal of Medicine, Stalmans et al. (2012). Enzymatic Vitreolysis with Ocriplasmin for Vitreomacular Traction and Macular Holes (MIVI-TRUST).
- Eye (London), peer-reviewed commentary (PMC7005710) (2019). Cochrane Corner: Ocriplasmin, why isn't it being used more?.
- Peer-reviewed pooled analysis (PMC7841271) (2021). Prognostic Factors Associated with Ocriplasmin Efficacy for Symptomatic Vitreomacular Adhesion and Full-thickness Macular Hole: Analysis from Four Studies.
- Acta Ophthalmologica, Gishti et al. (2019). Symptoms related to posterior vitreous detachment and the risk of developing retinal tears: a systematic review.
- American Academy of Ophthalmology (EyeSmart) (2024). Detached Retina: What Is a Torn or Detached Retina?.
- Ophthalmology Retina, peer-reviewed cohort study (2017). Cataract Formation and Progression in Patients Less Than 50 Years of Age after Vitrectomy.