Ocular Diagnostic and Peri-Operative Preparations and Photodynamic Treatment

NHSL Medicines Guidance
NHS Lanarkshire

Ocular Diagnostic Preparations

Specialist initiation (S1)

FLUORET STRIPS®

  • Used to detect corneal abrasions/lesions and foreign bodies.

  • They are also used in tonometry.

  • Primary care = may be ordered by medical practitioners on Form GP10A only.

FLUORESCEIN 1% or 2% eye drops

  • Eye drops are usually only used for diagnosis of naso–lachrymal duct patency and leakage of eye wounds.

Prescribing Notes:

  • For detection of corneal abrasions, strips are preferred since the drops may not fluoresce properly if too much is instilled into the eye.

Ocular Peri-Operative Drugs

Specialist use only (S2)

KETOROLAC 0.5% eye drops

DICLOFENAC SODIUM 0.1% eye drops

NEPAFENAC 1mg/ml eye drops

  • Indication: Reduction in the risk of postoperative macular oedema associated with cataract surgery in diabetic patients.

FLURBIPROFEN 0.03% eye drops 0.4ml unit dose

  • Indication: The inhibition of intraoperative miosis. Flurbiprofen does not have intrinsic mydriatic properties and does not replace mydriatic agents.
  • Also for the management of post-operative and post-laser trabeculoplasty inflammation in the anterior segment of the eye in patients in whom steroid therapy is not recommended.

Subfoveal Choroidal Neovascularisation

Specialist use only (S2)

RANIBIZUMAB 10mg/ml solution for intravitreal injection

Indications:

  • Visual impairment due to choroidal neovascularisation secondary to pathologic myopia in adults.
  • Visual impairment due to macular oedema (MO) secondary to retinal vein occlusion (RVO) (branch RVO or central RVO) in adults.
  • Visual impairment due to diabetic macular oedema (DMO) in adults with best corrected visual acuity (BCVA) 75 Early Treatment Diabetic Retinopathy Study (ETDRS) letters or less at baseline.

BROLUCIZUMAB 120mg/ml solution for intravitreal injection

AFLIBERCEPT 40mg/ml solution for intravitreal injection (Eylea®)

Indications:

  • Treatment of neovascular (wet) age-related macular degeneration.
  • Visual impairment due to macular oedema secondary to central retinal vein occlusion.
  • Visual impairment due to macular oedema secondary to branch retinal vein occlusion.
  • Visual impairment due to diabetic macular oedema (DMO).
    SMC Restriction: adults with best corrected visual acuity (BCVA) 75 Early Treatment Diabetic Retinopathy Study (ETDRS) letters or less at baseline.
  • Visual impairment due to choroidal neovascularisation secondary to pathologic myopia in adults.

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.