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Macular pucker treatment
I have been diagnosed with bilateral macular pucker. given choice of investigative injection of eye with a new drugs, believe started in Europe and or surg. what to do?
I recently had to undergo a emergency vitrectomy due to PVD,and much to my dismay my vision has changed drastically from 20/21 to 20/50.I tested myself the other night to see how I would drive at night and found I had considerable difficulty I need to do so as it is part of my work schedule.Dr. Ruby performed the surgery as you were not available.I suspect macular pucker.Any comments or suggestions would be appreciated Your patient Richard Tomasisk
I'm sorry about your macular pucker.
From what I have read, macular pucker normally results from growth of a membrane (epiretinal membrane or ERM for short) across the retina at the back of the eye. As this membrane thickens and contracts, it can 'pucker' and distort vision (as well as cause blurring and other symptoms).
The injectable drug you've been offered is probably Jetrea. It was approved by the FDA in late 2012 to treat adhesion in the eye between the vitreous and the macula (the central retina). It's also been approved for this purpose in the EU, England and Canada (and maybe elsewhere).
The approval for Jetrea is for vitreomacular adhesion (VMA), not for macular pucker of an epiretinal membrane.
From the few studies and reviews I have read, patients with both VMA and ERM may have release of the VMA through a Jetrea injection. It sounds like Jetrea can be a useful 'first try' to release VMA, and for some patients allows them to avoid a vitrectomy procedure to release the adhesion (if the injection works).
But I don't think it's normally used for patients with a macular pucker caused by ERM alone, who don't also have vitreous adhesion.
Since Jetrea has risks as most meds do, and if it is not routinely used to relieve the cause of your specific macular pucker, you should certainly know that before you have the injection.
If your pucker is an ERM and you do not also have VMA, and Jetrea is being suggested, perhaps that's why the doctor referred to it as an 'investigative use' of the injection.
It would be good to talk with your doctor about exactly what is causing the macular pucker, and if Jetrea has been used before to treat that specific cause.
After some online searching, I did find a Q&A from Feb 2013 on this exact topic with a retina specialist from William Beaumont Hospital in Royal Oak, Mich, as follows:
Question:
"Is there any treatment for a macular pucker other than surgery? My doctor had mentioned that there was a new medication for it"
Answer:
The new medication, Jetrea, is an option for a select group of patients with macular pucker who previously could only be treated with surgery. Whether you are a candidate for Jetrea depends on the status of the vitreous and the size of the macular pucker. Most patients with macular pucker are not candidates for Jetrea."
Answered by: George Williams, MD
If I were you, I would ask your doctor about the potential risks of Jetrea, and also about your specific retina problem and why your doctor feels your case might respond to Jetrea (since it is not common to use Jetrea for macular pucker).
If you go forward, you might also have only one eye injected at a time, to see how your vision changes, before injecting the other eye. Best of luck to you.
From what I have read, macular pucker normally results from growth of a membrane (epiretinal membrane or ERM for short) across the retina at the back of the eye. As this membrane thickens and contracts, it can 'pucker' and distort vision (as well as cause blurring and other symptoms).
The injectable drug you've been offered is probably Jetrea. It was approved by the FDA in late 2012 to treat adhesion in the eye between the vitreous and the macula (the central retina). It's also been approved for this purpose in the EU, England and Canada (and maybe elsewhere).
The approval for Jetrea is for vitreomacular adhesion (VMA), not for macular pucker of an epiretinal membrane.
From the few studies and reviews I have read, patients with both VMA and ERM may have release of the VMA through a Jetrea injection. It sounds like Jetrea can be a useful 'first try' to release VMA, and for some patients allows them to avoid a vitrectomy procedure to release the adhesion (if the injection works).
But I don't think it's normally used for patients with a macular pucker caused by ERM alone, who don't also have vitreous adhesion.
Since Jetrea has risks as most meds do, and if it is not routinely used to relieve the cause of your specific macular pucker, you should certainly know that before you have the injection.
If your pucker is an ERM and you do not also have VMA, and Jetrea is being suggested, perhaps that's why the doctor referred to it as an 'investigative use' of the injection.
It would be good to talk with your doctor about exactly what is causing the macular pucker, and if Jetrea has been used before to treat that specific cause.
After some online searching, I did find a Q&A from Feb 2013 on this exact topic with a retina specialist from William Beaumont Hospital in Royal Oak, Mich, as follows:
Question:
"Is there any treatment for a macular pucker other than surgery? My doctor had mentioned that there was a new medication for it"
Answer:
The new medication, Jetrea, is an option for a select group of patients with macular pucker who previously could only be treated with surgery. Whether you are a candidate for Jetrea depends on the status of the vitreous and the size of the macular pucker. Most patients with macular pucker are not candidates for Jetrea."
Answered by: George Williams, MD
If I were you, I would ask your doctor about the potential risks of Jetrea, and also about your specific retina problem and why your doctor feels your case might respond to Jetrea (since it is not common to use Jetrea for macular pucker).
If you go forward, you might also have only one eye injected at a time, to see how your vision changes, before injecting the other eye. Best of luck to you.
MEDICAL PROFESSIONAL
I would have surgery. A macular pucker surgery is very successful. There is an approved for VMT but not macular pucker.
Dr. O.
Dr. O.
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