Evidence-based guidelines for drug dosing in intravitreal injections in silicone oil-filled eyes: Pharmacokinetics, safety, and optimal dosage
Year: 2024
Type: review
Abstract: We evaluate the pharmacokinetics, safety, and optimal dosages of intravitreal agents in silicone oil (SO)-filled eyes, addressing challenges in administering such therapies. We assessed the pharmacological properties and safety profiles of intravitreal drugs in SO-filled eyes, deriving conclusions and guidance from available literature and expert consensus. Preclinical data suggest comparable half-lives of anti-vascular endothelial growth factoragents in SO-filled eyes, but clinical evidence is mainly from case reports and small series. Available research prioritizes standard dosages, particularly for bevacizumab (1.25 mg), supported by stronger evidence than aflibercept (2 mg) or ranibizumab (0.5 mg). Intravitreal steroids, especially dexamethasone at 0.7 mg, show efficacy and safety, while evidence for fluocinolone acetonide at 0.19 mg is limited. Intravitreal methotrexate has been reported at the dosage of 250-400 μg, with keratitis as the primary expected side effect. Case reports indicate tolerability of standard dosages of antivirals (foscarnet 1.2-2.4 mg/0.1 mL, ganciclovir 4 mg/0.1 mL) and the antibiotic combination piperacillin/tazobactam (250 μg/0.1 mL). We offer guidance based on current, but limited, literature. Standard dosage of intravitreal agents should be carefully considered, along with close monitoring for potential side effects, which should be discussed with patients.
Source: Survey of Ophthalmology
Authors: Lorenzo Ferro Desideri, Peng Yong Sim, Enrico Bernardi, Karin Paschon, Janice Roth, Adrian T. Fung, Xia Ni Wu, Hung-Da Chou, Robert Henderson, Edmund Tsui, Maria Berrocal, Jay Chhablani, Charles C. Wykoff, Chui Ming Gemmy Cheung, Giuseppe Querques, Gustavo Barreto Melo, Yousif Subhi, Anat Loewenstein, Jens Folke Kiilgaard, Martin Zinkernagel, Rodrigo Anguita
Institutions: University of Bern, University Hospital of Bern, Moorfields Eye Hospital NHS Foundation Trust, The University of Sydney, Macquarie University, Fremantle Hospital, Chang Gung University, Linkou Chang Gung Memorial Hospital, University of California, Los Angeles, University of Puerto Rico System, University of Pittsburgh, Houston Methodist, Retina Consultants of Texas, National University of Singapore, Singapore National Eye Center, Singapore Eye Research Institute, Duke-NUS Medical School, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele, IRCCS San Raffaele Roma, Universidade Federal de São Paulo, Copenhagen University Hospital, Tel Aviv University
Language: English
Topic: Retinal and Macular Surgery
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,770
OpenAlex ID: W4402913469