Ocular peri-operative drugs

Diclofenac sodium

• Single use preservative free eye drops 0.1% (£4.00 = 5 unit dose)

Indications

• For intraoperative and postoperative use

Notes

1. Very few patients require long term therapy and this will usually be under the supervision of an Ophthalmologist.

Ketorolac

• Eye drops 0.5% (£6.15 = 5ml)

Indications

• Prophylaxis and reduction of inflammation and associated symptoms following ocular surgery

Acetylcholine chloride

• Powder and solvent for solution for intraocular irrigation ampoules 20mg

Ethanol

• Eye drops preservative free 18% (unlicensed preparation)

Fluorouracil

• 6mg in 0.24ml to deliver 5mg injection (unlicensed preparation)

Hydroxypropyl methylcellulose (HPMC)

• OcuCoat solution 2% (intraocular and topical)
• Intraocular 2% in balanced salt solution
• Topical solution 1%

Mitomycin

• 0.2mg in 1ml syringe, 0.4mg in 1ml syringe (unlicensed preparation)
• Eye drops 0.02%, 0.04% (unlicensed preparation)

Mydricaine

• Formula No1 (unlicensed preparation)
• Formula No2 (unlicensed preparation)

Sodium hyaluronate

• Healonid pre-filled syringe sodium hyaluronate 1% 0.85ml
• Healonid 5 pre-filled syringe 23mg in 1ml (0.6ml pre-filled syringe)

Viscoat®

• Pre-filled syringe; sodium chondroitin sodium and sodium hyaluranate 0.5ml

Emergency use

Potassium ascorbate

• Eye drops preservative free (equivalent to ascorbic acid 10%) (unlicensed preparation)

Sodium Citrate

• Eye drops preservative free 10.11% (equivalent to citrate 6.5%) (unlicensed preparation)

Antineovascularisation agents

Aflibercept

• Solution for intravitreal injection vials 4mg/100microlitres, 30.1mg/263microlitres

Notes

1. NICE TA294: Aflibercept solution for injection (Eylea) is recommended as an option for treating wet age-related macular degeneration (July 2013), only if:
   1. it is used in accordance with the recommendations for ranibizumab in NICE TA155 and
   2. the manufacturer provides it with the discount agreed in the patient access scheme.
2. NICE TA305: Aflibercept solution for injection (Eylea) is recommended as an option for treating visual impairment caused by macular oedema secondary to central retinal vein occlusion only if the manufacturer provides it with the discount agreed in the patient access scheme (February 2014).
3. NICE TA307: Aflibercept (Zaltrap) in combination with irinotecan and fluorouracil-based therapy is not recommended within its marketing authorisation for treating metastatic colorectal cancer that is resistant to or has progressed after an oxaliplatin-containing regimen (March 2014).
4. NICE TA346: Aflibercept solution for injection (Eylea) is recommended as an option for treating visual impairment caused by diabetic macular oedema (July 2015), only if:
   1. the eye has a central retinal thickness of 400micrometres or more at the start of treatment and
   2. the company provides it with the discount agreed in the patient access scheme.
5. NICE TA409: Aflibercept (Eylea) is recommended as an option within its marketing authorisation for treating visual impairment  in adults caused by macular oedema after branch retinal vein occlusion, only if the company provides it with the discount agreed in the patient access scheme (September 2016).
6. NICE TA486: Aflibercept (Eylea) is recommended, within its marketing authorisation, as an option for treating visual impairment because of choroidal neovascularisation in adults, only if the company provides it with the discount agreed in the patient access scheme (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).

Bevacizumab gamma

• Solution for injection vial 25mg/ml

Notes

1. NICE TA1022: Bevacizumab gamma (Lytenava) is recommended as an option for treating wet age-related macular degeneration in adults, 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 area 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 it according to the commercial arrangement (December 2024).
2. Refer to TA1022 for additional considerations and continuation / stopping criteria.

Brolucizumab

• Solution for intravitreal injection pre-filled syringes 19.8mg/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 and
   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 vials 28.8mg/0.24ml

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 400micrometres or more at the start of treatment and
   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.
3. NICE TA1004: Faricimab (Vabysmo) is recommended, within its marketing authorisation, as an option for treating visual impairment caused by macular oedema after central or branch retinal vein occlusion in adults, only if the company provides it according to the commercial arrangement (September 2024).

Ranibizumab

• Solution for intravitreal injection pre-filled syringes 1.65mg/0.165ml
• Solution for intravitreal injection vials 2.3mg/0.23ml

Notes

1. NICE TA155: Ranibizumab (Lucentis), within its marketing authorisation, is recommended as an option for the treatment of wet age-related macular degeneration (August 2008), only if:
   1. all of the following circumstances apply in the eye to be treated:
      1. the best-corrected visual acuity is between 6/12 and 6/96
      2. there is no permanent structural damage to the central fovea
      3. the lesion size is less than or equal to 12 disc areas in greatest linear dimension
      4. there is evidence of recent presumed disease progression (blood vessel growth, as indicated by fluorescein angiography, or recent visual acuity changes) and
   2. the manufacturers of ranibizumab (branded or biosimilar) provide it at a discount level no lower than the discount agreed in the patient access scheme.
2. NICE TA274: Ranibizumab (Lucentis) is recommended as an option for treating visual impairment due to diabetic macular oedema (February 2013), only if:
   1. the eye has a central retinal thickness of 400micrometres or more at the start of treatment and
   2. the manufacturers of ranibizumab (branded or biosimilar) provide it at a discount level no lower than the discount agreed in the patient access scheme.
3. NICE TA283: Ranibizumab (Lucentis) is recommended as an option for treating visual impairment caused by macular oedema (May 2013):
   1. following central retinal vein occlusion or
   2. following branch retinal vein occlusion only if treatment with laser photocoagulation has not been beneficial, or when laser photocoagulation is not suitable because of the extent of macular haemorrhage, and
   3. only if the manufacturers or ranibizumab (branded or biosimilar) provide it at a discount level no lower than provides it with the discount agreed in the patient access scheme.
4. NICE TA298: Ranibizumab (Lucentis) is recommended as an option for treating visual impairment due to choroidal neovascularisation secondary to pathological myopia only if the manufacturers of ranibizumab (branded or biosimilar) provide it at a discount level no lower than the discount agreed in the patient access scheme (November 2013).

Verteporfin

• Powder for solution for infusion vials 15mg

Notes

1. NICE TA68: Use of photodynamic therapy for age-related macular degeneration (September 2003)

Pegaptanib

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.