INTRAVITREAL DRUGS

Dr.Prathibha.M.Chachadi

How to give ?

         

Informed consent Dilated pupil Opd/operation theatre Aseptic measures Anaesthetic drops Lid speculum Mark the site of injection Loading the drug Injecting the drug Post injection precautions & medications

Drug used & its Indications



Antimicrobials

Acute post operative endophthalmitis Delayed onset post operative endophthalmitis Conjunctival bleb related endophthalmitis Acute retinal necrosis Cytomegalovirus retinitis


Anti VEGF Silicon oil & Gas Tpa Steroids

Choroidal neovascular membrane Diabetic macular edema

  

Retinal detachment vein occlusions-CRVO occlusionsRefractory CME Macular edema+CRVO Exudative macular degeneration

Antimicrobials
Drug gentamicin tobramycin amikacin cefazolin cefatazidime ciprofloxacin vancomycin AmphotericinAmphotericin-B Acyclovir ganciclovir Dosage -mg/0.1ml 0.1 0.1 0.4 2.25 2.25 0.1 1 0.005[5microg] 0.08[80microg] 400400-2000microg

Preparation of intravitreal dose

drug Vial size Initial concentr ation
50mg/ml

aliquot

Add ns

Dose mg/0.1m l
0.4

-life

amikacin

100mg/2ml

0.2ml

2.3ml

20-40hrs 20-

Cefazolin &ceftazidime

500mg/2ml

250mg/ml

0.1ml

0.9ml

2.5

15-38hrs 15-

vancomycin

5oomg/10ml

50mg/ml

0.2ml

0.8ml

22-54hrs 22-

Gentamycin

80mg/2ml

40mg/ml

0.1ml

1.9ml

0.2

Amphoterici n-B ganciclovir

50mg/10ml

5mg/ml

0.1ml

0.9ml

5microg

500mg/10m l

50mg/ml

0.8ml

0.2ml

800microg

Steroids
drug Dosage[mg/0.1ml]

Dexamethasone[25]

0.4

Triamcenalone acetate[5]

4 [half lifelife18.6days;complete eliminationelimination-3 months]

Anti VEGF
Drug Bevacizumab[ avastin] Dosage 1.25 to 2.25mg

Ranibizumab[lucentis 0.3mg or 0.5mg ] Pegabtanib[macugen ] 0.3mg

Pharmacodynamics
  

Therapeutic window Blood ocular barriers Factors affecting absorption of a drug

Ph Lipid solubility Mol wt Protein binding Inflammation others

Distribution & elimination

Dosage used Extent & volume of distribution Rate of elimination- apparent volume of distribution elimination& life of drug Route of elimination- anterior/posterior elimination-

Complications of intravitreal injection

 
  

Due to procedure Due to drugs

Antibiotics Steroids-cataract, increased IOP SteroidsAnti-VEGFAnti-VEGF-systemic complications

Retinal toxicity
gentamicin c/fc/f- macular infarction, retinal necrosis,vascular occlusion,retinal detachment, Vitreous clouding, retinal opacification Macular cysts, holes, outer retinal damage At higher doses disorganisation of retinal layers ;papillitis; optic atrophy

vancomycin ceftazidime clindamycin

Amphotericin - Vitreous inflammation, retinal haemorhages, B retinal detatchment, retinal necrosis, chorioretinal scarring ganciclovir Retinal opacification, peripapillary haemorhages,RPE changes, vascular sclerosis

  

Drug interactions Combination of drugs Repetition of injections

References
 

Text book of ophthalmology-Dutta,vol 3 ophthalmologyPosterior segment complications- P.N.Nagpal complications-