11.8.2 Ocular diagnostic and peri-operative preparations and photodynamic treatment

Fluorescein sodium single use drops
  • 1%, 2% (£9.25 = 20 units)

Notes

  1. Fluorescein is the standard preparation to detect ocular lesions and foreign bodies.
  2. Contact lenses, if worn, should be removed and 1 drop applied to damaged areas.
  3. Conjunctival abrasions stain yellow or orange, corneal abrasions or ulcers stain bright green and foreign bodies are surrounded by a green ring. Excess should be washed away with sodium chloride solution 0.9%.

Ocular peri-operative drugs

Acetylcholine chloride
  • Intra-ocular irrigation 20mg vial
Diclofenac sodium
  • single use eye drops 0.1%
Flurbiprofen sodium
  • Ophthalmic solution
Ketorolac
  • Eye drops 0.5% 5ml

Miscellaneous products

Disodium edetate (EDTA)
  • Eye drops 0.37% (Moorfields)
Hydroxypropyl methylcellulose (HPMC)
  • Brands include OcuCoat®
Sodium hyaluronate
  • Brands include Viscoat®, Provisc®
Potassium ascorbate
  • Eye drops

Indication

  • Chemical burns
Sodium citrate
  • Eye drops 10.11% (equivalent to citrate 6.5%)

Indication

  • Chemical burns
Sodium chloride
  • Eye drops 5% 10ml
  • Eye drops 5% - preservative free 10ml

Indication

  • Corneal oedema

Subfoveal choroidal neovascularisation

Aflibercept
  • Solution for intravitreal injection 0.1ml vial, 40mg/ml

Notes

  1. NICE TA294 - Aflibercept solution for injection for treating wet-age related macular degeneration (July 2013)
  2. NICE TA305 - Macular oedema (central retinal vein occlusion) - aflibercept solution for injection (February 2014)
  3. NICE TA307: Aflibercept (Zaltrap) in combination with irinotecan and fluorouracil-based therapy is not recommended for treating metastatic colorectal cancer that is resistant to or has progressed after an oxaliplatin-containing regime (March 2014)
  4. NICE TA346 - Aflibercept for treating diabetic macular oedema (July 2015)
  5. NICE TA409 - Aflibercept fortreating visual impairment caused by macular oedema after branch retinal veinocclusion (September 2016)
  6. NICE TA486 - Aflibercept for treating choroidal neovascularisation (November 2017)
  7. MHRA Drug Safety Update (July 2020): Systemically administered VEGF pathway inhibitors: risk of aneurysm and artery dissection
    • Before initiating a systemic VEGF pathway inhibitor, carefully consider the risk of aneurysm and artery dissection in patients with risk factors (see Drug Safety Update for a list of risk factors)
    • In patients who receive a systemic VEGF pathway inhibitor, reduce as far as possible any modifiable risk factors such as smoking and hypertension
    • Monitor patients for and treat hypertension in accordance with recommendations in the SPC (click here)
Brolucizumab
  • Solution for intravitreal injection, prefilled syringes 19.8mg in 0.165ml

Notes:

  1. NICE TA672: Brolucizumab is recommended as an option for treating wet age-related macular degeneration in adults only when the criteria of the NICE TA are met (February 2021)
  2. NICE TA820: Brolucizumab (Beovu) is recommended as an option for treating visual impairment due to diabetic macular oedema in adults (August 2022), only if:
    1. the eye has a central retinal thickness of 400 micrometres or more at the start of treatment
    2. the company provides brolucizumab according to the commercial arrangement.
    3. If patients and their clinicians consider brolucizumab to be 1 of a range of suitable first-line treatments (including aflibercept and ranibizumab), choose the least expensive treatment. Take account of administration costs, dosage, price per dose and commercial arrangements.
  3. MHRA Drug Safety Update (January 2022): Brolucizumab (Beovu): risk of intraocular inflammation and retinal vascular occlusion increased with short dosing intervals
Faricimab
  • Solution for injection 120mg in 1ml

Notes

  1. NICE TA799: Faricimab (Vabysmo) is recommended as an option for treating visual impairment due to diabetic macular oedema in adults (June 2022), only if:
    1. the eye has a central retinal thickness of 400 micrometres or more at the start of treatment
    2. the company provides faricimab according to the commercial arrangement
    3. If patients and their clinicians consider faricimab to be 1 of a range of suitable treatments (including aflibercept and ranibizumab), choose the least expensive treatment. Take account of administration costs, dosage, price per dose and commercial arrangements
  2. NICE TA800: Faricimab (Vabysmo) is recommended as an option for treating wet age-related macular degeneration in adults (June 2022), only if:
    1. the eye has a best-corrected visual acuity between 6/12 and 6/96
    2. there is no permanent structural damage to the central fovea
    3. the lesion size is 12 disc areas or less in greatest linear dimension
    4. there are signs of recent disease progression (for example, blood vessel growth as shown by fluorescein angiography, or recent visual acuity changes)
    5. the company provides faricimab according to the commercial arrangement
    6. If patients and their clinicians consider faricimab to be 1 of a range of suitable treatments (including aflibercept and ranibizumab), choose the least expensive treatment. Take account of administration costs, dosage, price per dose and commercial arrangements
    7. Refer to TA800 for continuation criteria and other considerations
Pegaptanib
  • Solution for intravitreal injection 300 microgram vial

Notes

  1. NICE TA155: Ranibizumab and pegaptanib for the treatment of age-related macular degeneration (August 2008)
    1. Pegaptanib (Macugen) is not recommended for the treatment of wet age-related macular degeneration
Ranibizumab
  • Solution for intravitreal injection pre-filled syringes 1.65mg in 0.165ml
  • Solution for intravitreal injection vials 2.3mg in 0.23ml

Notes

  1. NICE TA155: Ranibizumab and pegaptanib for the treatment of age-related macular degeneration (August 2008)
    1. Ranibizumab ((Lucentis) is recommended as an option for the treatment of wet age-related macular degeneration only when criteria of the NICE TA are met
  2. NICE TA274 - Ranibizumab for treating diabetic macular oedema (April 2013)
  3. NICE TA283 - Ranibizumab - macular oedema (retinal vein occlusion) (May 2013)
  4. NICE TA298 - Ranibizumab for choroidal neovascularisation (November 2013)
Verteporfin
  • Injection 15mg

Notes

  1. NICE TA68 - Verteporfin photodynamic therapy for wet age-related macular degeneration (September 2003)
Ocriplasmin
  • Solution for intravitreal injection vials 0.375mg in 0.3ml

Notes

  1. NICE TA297 - Vitreomacular traction - ocriplasmin (October 2013)

 

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