Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, Bern CH-3010, Switzerland; Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department for BioMedical Research, University of Bern, Murtenstrasse 24, Bern CH-3008, Switzerland.
Moorfields Eye Hospital NHS Foundation Trust, London, UK.
Surv Ophthalmol. 2025 Jan-Feb;70(1):96-105. doi: 10.1016/j.survophthal.2024.09.006. Epub 2024 Sep 27.
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.
我们评估了硅油 (SO) 填充眼内制剂的药代动力学、安全性和最佳剂量，以解决这些治疗方法的应用挑战。我们评估了 SO 填充眼中的眼内药物的药理学特性和安全性概况，从现有文献和专家共识中得出结论和指导。临床前数据表明，抗血管内皮生长因子药物在 SO 填充眼中的半衰期相当，但临床证据主要来自病例报告和小系列研究。现有研究优先考虑标准剂量，特别是贝伐单抗（1.25mg），其证据比阿柏西普（2mg）或雷珠单抗（0.5mg）更充分。眼内皮质类固醇，特别是 0.7mg 的地塞米松，显示出疗效和安全性，而氟轻松醋酸酯 0.19mg 的证据有限。有报道称，眼内甲氨蝶呤的剂量为 250-400μg，以角膜炎为主要预期副作用。病例报告表明，抗病毒药物（喷昔洛韦 1.2-2.4mg/0.1mL，更昔洛韦 4mg/0.1mL）和抗生素组合哌拉西林/他唑巴坦（250μg/0.1mL）的标准剂量具有耐受性。我们根据目前但有限的文献提供指导。应仔细考虑眼内制剂的标准剂量，并密切监测潜在的副作用，应与患者讨论这些副作用。
