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
{"title":"基于证据的硅油填充眼玻璃体内注射药物剂量指南:药代动力学、安全性和最佳剂量。","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","doi":"10.1016/j.survophthal.2024.09.006","DOIUrl":null,"url":null,"abstract":"<p><p>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.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":null,"pages":null},"PeriodicalIF":5.1000,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Evidence-based guidelines for drug dosing in intravitreal injections in silicone oil-filled eyes: Pharmacokinetics, safety, and optimal dosage.\",\"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\",\"doi\":\"10.1016/j.survophthal.2024.09.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>We evaluate the pharmacokinetics, safety, and optimal dosages of intravitreal agents in silicone oil (SO)-filled eyes, addressing challenges in administering such therapies. 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Evidence-based guidelines for drug dosing in intravitreal injections in silicone oil-filled eyes: Pharmacokinetics, safety, and optimal dosage.
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.
期刊介绍:
Survey of Ophthalmology is a clinically oriented review journal designed to keep ophthalmologists up to date. Comprehensive major review articles, written by experts and stringently refereed, integrate the literature on subjects selected for their clinical importance. Survey also includes feature articles, section reviews, book reviews, and abstracts.