intravitreal drugs
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INTRAVITREAL INTRAVITREAL DRUGSDRUGS
Dr.Prathibha.M.ChachadiDr.Prathibha.M.Chachadi
How to giveHow to give ? ?
Informed consentInformed consent Dilated pupilDilated pupil Opd/operation theatreOpd/operation theatre Aseptic measuresAseptic measures Anaesthetic dropsAnaesthetic drops Lid speculumLid speculum Mark the site of injectionMark the site of injection Loading the drugLoading the drug Injecting the drugInjecting the drug Post injection precautions & medicationsPost injection precautions & medications
Drug used & its IndicationsDrug used & its Indications Antimicrobials Antimicrobials Acute post operative endophthalmitisAcute post operative endophthalmitisDelayed onset post operative endophthalmitisDelayed onset post operative endophthalmitisConjunctival bleb related endophthalmitisConjunctival bleb related endophthalmitisAcute retinal necrosisAcute retinal necrosisCytomegalovirus retinitisCytomegalovirus retinitis Anti –VEGFAnti –VEGFChoroidal neovascular membraneChoroidal neovascular membraneDiabetic macular edemaDiabetic macular edema Silicon oil & GasSilicon oil & GasRetinal detachmentRetinal detachment TpaTpavein occlusions-CRVOvein occlusions-CRVO Steroids Steroids Refractory CMERefractory CMEMacular edema+CRVOMacular edema+CRVOExudative macular degenerationExudative macular degeneration
AntimicrobialsAntimicrobials DrugDrug Dosage -mg/0.1mlDosage -mg/0.1ml
gentamicingentamicin 0.10.1
tobramycintobramycin 0.10.1
amikacinamikacin 0.40.4
cefazolincefazolin 2.252.25
cefatazidimecefatazidime 2.252.25
ciprofloxacinciprofloxacin 0.10.1
vancomycinvancomycin 11
Amphotericin-BAmphotericin-B 0.005[5microg]0.005[5microg]
AcyclovirAcyclovir 0.08[80microg]0.08[80microg]
ganciclovirganciclovir 400-2000microg400-2000microg
Preparation of intravitreal dosePreparation of intravitreal dosedrugdrug Vial sizeVial size InitialInitial
concentrconcentrationation
aliquotaliquot Add nsAdd ns Dose Dose mg/0.1mlmg/0.1ml
½-life½-life
amikacinamikacin 100mg/2ml100mg/2ml 50mg/ml50mg/ml 0.2ml0.2ml 2.3ml2.3ml 0.40.4 20-40hrs20-40hrs
Cefazolin Cefazolin &ceftazidim&ceftazidimee
500mg/2ml500mg/2ml 250mg/ml250mg/ml 0.1ml0.1ml 0.9ml0.9ml 2.52.5 15-38hrs15-38hrs
vancomycinvancomycin 5oomg/10ml5oomg/10ml 50mg/ml50mg/ml 0.2ml0.2ml 0.8ml0.8ml 11 22-54hrs22-54hrs
GentamycinGentamycin 80mg/2ml80mg/2ml 40mg/ml40mg/ml 0.1ml0.1ml 1.9ml1.9ml 0.20.2
AmphotericiAmphotericin-Bn-B
50mg/10ml50mg/10ml 5mg/ml5mg/ml 0.1ml0.1ml 0.9ml0.9ml 5microg5microg
ganciclovirganciclovir 500mg/10ml500mg/10ml 50mg/ml50mg/ml 0.8ml0.8ml 0.2ml0.2ml 800microg800microg
SteroidsSteroids
drugdrug Dosage[mg/0.1ml]Dosage[mg/0.1ml]
Dexamethasone[25]Dexamethasone[25] 0.40.4
Triamcenalone Triamcenalone acetate[5]acetate[5]
4 4 [half life- [half life- 18.6days;complete 18.6days;complete elimination-3 months]elimination-3 months]
Anti VEGFAnti VEGF
DrugDrug DosageDosage
Bevacizumab[ Bevacizumab[ avastiavasti
nn]]1.25 to 2.25mg1.25 to 2.25mg
Ranibizumab[Ranibizumab[lucentislucentis
]]0.3mg or 0.5mg0.3mg or 0.5mg
Pegabtanib[Pegabtanib[macugenmacugen]] 0.3mg0.3mg
PharmacodynamicsPharmacodynamics Therapeutic windowTherapeutic window Blood ocular barriersBlood ocular barriers Factors affecting absorption of a drugFactors affecting absorption of a drugPhPhLipid solubilityLipid solubilityMol wtMol wtProtein bindingProtein bindingInflammationInflammationothersothers
Distribution & eliminationDistribution & eliminationDosage usedDosage used
Extent & volume of distributionExtent & volume of distribution
Rate of elimination- apparent volume of distribution Rate of elimination- apparent volume of distribution & ½ life of drug& ½ life of drug
Route of elimination- anterior/posteriorRoute of elimination- anterior/posterior
Complications of intravitreal injectionComplications of intravitreal injection
Due to procedureDue to procedure Due to drugsDue to drugs Antibiotics Antibiotics Steroids-cataract, increased IOPSteroids-cataract, increased IOP Anti-VEGF-systemic complicationsAnti-VEGF-systemic complications
Retinal toxicityRetinal toxicity
gentamicingentamicin c/f- macular infarction, retinal c/f- macular infarction, retinal necrosis,vascular occlusion,retinal necrosis,vascular occlusion,retinal detachment,detachment,
vancomycinvancomycin Vitreous clouding, retinal opacificationVitreous clouding, retinal opacification
ceftazidimeceftazidime Macular cysts, holes, outer retinal damageMacular cysts, holes, outer retinal damage
clindamycinclindamycin At higher doses disorganisation of retinal At higher doses disorganisation of retinal layers ;papillitis; optic atrophylayers ;papillitis; optic atrophy
Amphotericin -Amphotericin -BB
Vitreous inflammation, retinal haemorhages, Vitreous inflammation, retinal haemorhages, retinal detatchment, retinal necrosis, retinal detatchment, retinal necrosis, chorioretinal scarringchorioretinal scarring
ganciclovirganciclovir Retinal opacification, peripapillary Retinal opacification, peripapillary haemorhages,RPE changes, vascular sclerosishaemorhages,RPE changes, vascular sclerosis
Drug interactionsDrug interactions Combination of drugsCombination of drugs Repetition of injectionsRepetition of injections
ReferencesReferences
Text book of ophthalmology-Dutta,vol 3Text book of ophthalmology-Dutta,vol 3 Posterior segment complications- P.N.NagpalPosterior segment complications- P.N.Nagpal
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