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
Choroidal neovascular membrane
Diabetic macular edema
 Silicon oil & Gas
Retinal detachment
 Tpa
vein occlusions-CRVO
 Steroids
Refractory CME
Macular edema+CRVO
Exudative macular degeneration
 Antimicrobials
Drug Dosage -mg/0.1ml

gentamicin 0.1
tobramycin 0.1
amikacin 0.4
cefazolin 2.25
cefatazidime 2.25
ciprofloxacin 0.1
vancomycin 1
Amphotericin-B 0.005[5microg]
Acyclovir 0.08[80microg]
ganciclovir 400-2000microg
 Preparation of intravitreal dose
drug Vial size Initial aliquot Add ns Dose ½-life
concentr mg/0.1m
ation l
amikacin 100mg/2ml 50mg/ml 0.2ml 2.3ml 0.4 20-40hrs

Cefazolin 500mg/2ml 250mg/ml 0.1ml 0.9ml 2.5 15-38hrs

&ceftazidime

vancomycin 5oomg/10ml 50mg/ml 0.2ml 0.8ml 1 22-54hrs

Gentamycin 80mg/2ml 40mg/ml 0.1ml 1.9ml 0.2

Amphoterici 50mg/10ml 5mg/ml 0.1ml 0.9ml 5microg

n-B

ganciclovir 500mg/10m 50mg/ml 0.8ml 0.2ml 800microg

l
 Steroids
drug Dosage[mg/0.1ml]

Dexamethasone[25] 0.4

Triamcenalone 4 [half life-

acetate[5] 18.6days;complete
elimination-3 months]
 Anti VEGF
Drug Dosage

Bevacizumab[ 1.25 to 2.25mg

avastin]

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
& ½ life of drug
Route of elimination- anterior/posterior
 Complications of intravitreal injection

 Due to procedure
 Due to drugs
 Antibiotics
 Steroids-cataract, increased IOP
 Anti-VEGF-systemic complications
 Retinal toxicity
gentamicin c/f- macular infarction, retinal
necrosis,vascular occlusion,retinal
detachment,
vancomycin Vitreous clouding, retinal opacification

ceftazidime Macular cysts, holes, outer retinal damage

clindamycin At higher doses disorganisation of retinal

layers ;papillitis; optic atrophy
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
 Posterior segment complications- P.N.Nagpal