Drugs For Hyphema

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Drug

Trade

Preparation

Usual Dose

Notes aminocaproic acid Amicar tranexamic acid

Carbopol syrup, 250mg/ml tabs, 500mg

30% aminocaproic acid in 2% carboxypolymethylenegel

50mg/kg PO Q4hr.

Q6hr

75mg/kg/day in 3 divided doses for 5 days

For hyphema1'2 Orthostatic hypotension is a significant side effect Topical therapy for hyphema3

Alternative therapy for traumatic hyphema4

'From Ophthalmology 1998:105:1715-1720.

2Not for pregnant women or patients with renal failure, coagulopathy. 3From Ophthalmology 1999:106:375-379. 4From Arch Ophthalmol 1997:115:1106-1112.

11. Anti-Angiogenesis Agents

Drug

Trade

Preparation

Usual Dose

Notes verteporfin

Visudyne pegaptanib sodium Macugen ranibizumab bevacizumab

Lucentis

Avastin triamcinolone acetate Kenalog

Soln, 2mg/ml (supplied as 15mg of lyophilized powder to be diluted in 7.5 ml of sterile water) 0.3 mg intravitreal Q6 weeks

0.3 mg or 0.5 mg intravitreal Qmonth 1.25 mg intravitreal

4.0 mg intravitreal 20 mg intravitral

See Appendix 7 For photodynamic therapy for subfoveal choroidal neovascularization

Note: Approved by the FDA for all subtypes (predominantly classic, minimally classic, occult) of CNV secondary to age-related macular degeneration1 Approved by the FDA for CNV secondary to AMD

Intravitreal injection of bevacizumab is an off-label use of the drug, there are no randomized clinical trials of its use for macular degeneration2 Intravitreal injection of triamcinolone acetate has been used in the treatment of macular edema of various etiologies and for CNVM secondary to AMD (particularly in combination with photodynamic therapy)

1 From N Engl J Med 2004; 351: 2805-2816.

2From Ophthalmology 2006:113:363-372.

12. Contact Lens Solutions

Identifying the best system for a patient involves evaluation of patient's needs, the type of lenses worn, allergies, solution sensitivities, and the lens replacement schedule. The efficacy of lens care systems has been carefully evaluated by the manufacturers and approved by the FDA as safe and effective. These systems are tested (and proven efficacious) when used all together (i.e., as a "system" not each isolated product).

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