Lecture on Ocular Pharmacology & Therapeutics For 4th Year MBBS Undergraduate Students By Prof. Dr. Hussain Ahmad Khaqan

1. Ocular Pharmacology & Therapeutics
Prof. Dr. Hussain Ahmad Khaqan
 MD
 FRCS(Glasgow)
 FCPS(Ophth.)
 FCPS(Vitreo Retina)
 MHPE (KMU)
 CICO(UK)
 CMT(UOL)
 Fellowship in Medical Retina (LMU, Munich)
 Fellowship in Vitreo Retinal Surgery (LMU, Munich)
 Consultant Ophthalmologist & Retinal Surgeon
Professor of Ophthalmology
Lahore General Hospital, Lahore
Ameer Ud Din Medical College, Lahore
Post Graduate Medical Institute, Lahore
Shaukat Khanum Memorial Cancer Hospital & Research Centre ,Lahore

2. TOPICAL Continue
• Only around 1-10% of most topical agents are
absorbed into the eye. Absorption is dependent on
ocular contact time, drug concentration, and tissue
permeability. Small lipophilic drugs pass through the
cornea, whereas larger hydrophilic drugs are generally
absorbed through conjunctiva and sclera. Topical
agents may be in aqueous solution (comfortable, no
blurring but very short ocular contact time), in
suspension (longer ocular contact time, but bottle
must be shaken and may get FB sensation), or in
ointment (liquefy at body temperature, longest ocular
contact time but blurs vision)

3. TECHNIQUE
• Ensure that patients know how to instill any topical medication, and
that they can physically manage it.
• If reliable self administration is not possible ensure that there is
somebody who can assist them
• Consider ways of making it easier eg. Lying flat, mirror positioning,
or eye-drop dispensers. Small bottles and single use vials tend to be
particularly difficult for the frail and elderly
• Leave atleast 5 min between instilling topical medication
• Keep the eye closed and put pressure over the lacrimal sac for 1-2
min to try to increase ocular and reduce systemic absorption
TOPICAL Continue

4. SUBCONJUNCTIVAL INJECTION
Technique
• Ensure adequate anesthesia (e.g. a couple of drops of
amethocaine).
• Under direct vision (or slit-lamp or operating
microscope) lift an area of conjunctiva to form a small
bleb and slowly inject (sharp needle).
Medications
• This route is most commonly used for post-operative
injections of corticosteroids and antibiotics, but may be
used in acute anterior segment inflammation to deliver
mydriatics and corticosteroids.

5. SUBTENON AND PERIBULBAR INJECTIONS
Medications
• Although primarily used for ocular anesthesia (e.g.
lidocaine, bupivacaine), these routes may be used for
delivering corticosteroids in posterior segment
inflammation, exudation, or macular edema.
Subtenon and peribulbar corticosteroids
Drug Dose
Triamcinolone acetate 40 mg
Methylprednisolone 40 mg

6. INTRAVITREAL INJECTION Continue
Technique
• This should be performed with appropriate anesthesia
under sterile condition, usually in theatre. It is either
performed immediately after a core vitrectomy to
administer intravitreal antibiotics (for endophthalmitis)
or may be used for delivering corticosteroids to treat
posterior segment exudation or macular edema.
• Insert a 25-gauge half-inch needle entering 3.5-4mm
post-limbus (if phakic) or 3.0 to 3.5 mm(if
aphakic/pseudophakic) and directed into the vitreous.
At the time of injection the needle tip should be clearly
visualized through the pupil

7. Medications
INTRAVITREAL INJECTION
Intravitreal antimicrobials
Drug Dose Reconstituted to
Vancomycin 1mg 0.1 ml
Amikacin 0.4mg 0.1 ml
Ceftazidime 2mg 0.1 ml
Amphotericin 5-10µg 0.1 ml
Ganciclovir 400µg 0.1 ml
Intravitreal corticosteroids
Drug Dose Reconstituted to
Triamcinolone acetate 2-4 mg 0.05 mg-0.1 ml

8. TOPICAL ANTIBIOTICS Continue
Anti-bacterials
Generic Forms Pres-free Frequency Proprietary
Chloramphenicol G or minims 0.5%
Oc 1%
Available G: see below
Oc: 3-4x/d
Chloromycetin
Ciprofloxacin G 0.3% No <=4x/h initially Ciloxan
Framycetin Oc 0.5% No Soframycin
Fusidic acid Gel 1% No 2x/d Fucithalamic
Gentamicin G or minims 0.3%
Special preparation of
1.5%
Available Garamycin
Genticin
Neomycin G 0.5%
Oc 0.5%
No Neosporin (neomycin/gramicidin/polymyxin B
sulphate)
Ofloxacin G 0.3% No Exocin
Polymyxin B sulphate Combination only
G or Oc 10000µ/ml
No Polyfax(PBS/ bacitracin)
Polytrim (PBS/trimethoprim)
Propamidineisethionate G 0.1%
Oc 0.15%
No G: 4x/d brolene
Frequency: BNF recommends for antibacterial eyedrops that they are administered at least every 2 h then reduce frequency as infection is controlled and
continue for 48h after healing. For ointments BNF recommends that they are used at night (with drops used during the day) or 3-4x/d if used alone.

9. Anti-fungals
Generic Forms Frequency
Amphotericin G 0.15% <= q 1h initially for fungal
keratitis reducing as
infection is controlled
Clotrimazole G 1%
Econazole G 1%
Flucytosine G 2%
Itraconazole G 1%
Miconazole G 1%
Natamycin G 5%
Anti-virals
Generic Forms Pres-free Frequency Proprietary
Acyclovir Oc 3% No 5x/d until
healed then
5x/d for 3 d
Zovirax
Ganciclovir Gel 0.15% No 5x/d until
healed then
3x/d for 1 wk
Virgin
Trifluoridine 1% No 9x/d viroptic
TOPICAL ANTIBIOTICS

10. TOPICAL ANTI-INFLAMMATORY AGENTS
Continue
Corticosteroids
Corticosteroids
Generic Forms Pres-free Frequency Proprietary
Betamethasone G 0.1%
Oc 0.1%
No G ≤ jourly Betnesol
Bista-
methasone
Dexamethason
e
G or minim
0.1%
Available ≤ half hourly Maxidex
Fluorometholo
ne
G 0.1% No ≤ hourly FML
Hydrocortisone
acetate
G 1%
Oc 0.5%
No
Prednisolone G or minim
0.5%
G 1%
Available ≤ hourly Predsol
Pred forte
Rimexolone G 1% No ≤ hourly Vexol
Frequency: potency and frequency of cortricosteroids should be titrated against degree
of inflammation in order to achieve control whilst minimizine side-effects

11. TOPICAL ANTI-INFLAMMATORY AGENTS
Corticosteroid/antibiotic combination
Corticosteroid Antibiotic Forms Frequency Proprietary
Betamethason
e 0.1%
Neomycin
0.5%
G ≤ 6x/d Betnesol N
Vista-
methasone N
Dexamethaso
ne 0.1%
Neomycin
0.35%
Polymyxin B
sulphate
G or Oc ≤ 6x/d Maxitrol
Tobramycin
0.3%
tobradex
Dexamethaso
ne 0.05%
Framycetin
0.5%
Gramicidin
0.005%
G or Oc ≤ 4x/d Sofradex
Predsol 0.5% Neomycin
0.5%
G ≤ 6x/d Predsol-N

12. ANTI-HISTAMINES AND OTHER
ANTI-INFLAMMATORY AGENTS Continue
Anti-histamines and other anti-allergic agents
Generic Forms Pres-free Frequency Proprietary
Antihistamine
Antazolinesulphate G No 2-3x/d Otrivine/antristine
Azelastine
hydrochloride
G No 2-4 x/d upto 6
wks
Optilast
Ketotifen G No 2 x/d Zaditen
Levocarbistine G No 2-4 x/d Livastin
Olopatadine G No 2 x/d upto 4
months
opatanaol
Others
Emedastine G No 2x/d Emadine
Lodoxamide G No 4x/d Alamide
Nedocromil sodium G No 2-4 x/d Rapitil
Sodium cromoglycate G No 4x/d Opticrom and
others

13. Other anti-inflammatory agents (NSAIDS type)
Generic Forms Pres-free Frequency Proprietary
Diclofenac
sodium
G 0.1% Available Single Voltarolophtha
Voltarolophtha
multi
Flurbiprofen
sodium
G 0.03% No Single ocufen
Ketorolac G 0.5% No 3 x/d acular
ANTI-HISTAMINES AND OTHER
ANTI-INFLAMMATORY AGENTS

14. TOPICAL GLAUCOMA MEDICATIONS
Continue
• Beta-blockers
Generic Forms Pres-free Frequency Proprietary
Betaxolol G 0.25% or 0.5% No 2x/d Betoptic
Carteolol
hydrochloride
G 1% No 2x/d Teoptic
Levobunolol G 0.5% No 1-2 x/d Betagan
Metipranolol G 0.1% Yes
Timolol maleate G 0.25% or 0.55%
Gel 0.1%
Gel 0.25% or 0.5%
Available
No
No
2 x/d
1x/d
1x/d
Timoptol
Nyogel
Timoptol-LA

15. • Prostaglandin analogue
TOPICAL GLAUCOMA MEDICATIONS
Continue
Generic Forms Pres-free Frequency Proprietary
Bimatoprost G 300µg/ml
0.03%
No 1x/d Lumigan
Latanoprost G 50µg/ml
0.005%
No 1x/d Xalatan
Travoprost G 40µg/ml
0.004%
No 1x/d travatan

16. • Sympathomimetics
• Carbonic anhydrase inhibitors
TOPICAL GLAUCOMA MEDICATIONS
Continue
Generic Forms Pres-free Frequency Proprietary
Apraclonidine G 0.5% or 1% No Single-3x/d for
<1 month
Iopidine
Brimonidine
tartrate
G 0.2% No 2x/d Alphagan
Dipivefrine
hydrochloride
G 0.1% No 2x/d Propine
Generic Forms Pres-free Frequency proprietary
Brinzolamide G 10mg/ml No 2-3 x/d Azopt
Dorzolamide G 2% No 3x/d or 2x/d of
with βblocker
trusopt

17. • Miotics
Generic Forms Pres-free Frequency proprietary
Carbachol G 3% No < 4x/d Isoptocarbachol
Pilocarpine G 0.5, 1, 2, 3 or
4%
Minims 2 or 4%
Gel 4%
Available <4x/d
1x/d
pilogel
TOPICAL GLAUCOMA MEDICATIONS
Continue

18. • Combination drops
Generic Forms Pres-free Frequency proprietary
Timolol +
brimonidine
G timolol 0.5%
Brimonidine 0.2%
No 2x/d Combigan
Timolol +
dorzolamide
G timolol 0.5%
Dorzolamide 2%
No 2x/d Cosopt
Timolol + latanoprost G timolol 0.5%
Latanoprost 0.005%
No 1x/d Xalacom
TOPICAL GLAUCOMA MEDICATIONS

19. TOPICAL MYDRIATICS
Generic Forms Pres-free Frequency proprietary
Antimuscarinic
Atropine
sulphate
G 0.5% or 1%
Minims or Oc
1%
Available Single- 1x/d Isopto
atropine
Cyclopentolate
hydrochloride
G or minims
0.5%
Available Single -3x/d Mydrilate
Homatropinehy
drobromide
G 1% No Single- 4x/d
Tropicamide G 0.5%
Minims 0.5%
or 1%
Available Single Mydriacyl
Sympathomimet
ic
Phenylephrine
G 10%
Minims 2.5%
or
Available
Single – 3x/d

20. TOPICAL ANAESTHETICS
Generic Forms Pres-free Frequency proprietary
Oxybuprocaine
hydrochloride
Minim 0.4% Yes Single Minim
(benoxinate)
Proxymetacaine
hydrochloride
Minim 0.5% Yes Single Minim
Tetracaine
hydrochloride
Minim 0.5%
or 1%
Yes Single Minim
(amethocaine)
Combinations with fluorescein
Proxymetacaine and
fluorescein
Minim
P(o.5%)
F (0.25%)
Yes Single Minim
Lidocaine and
fluorescein
Minim L
(4%)
F (0.25%)
Yes Single Minim

21. TOPICAL TEAR REPLACEMENT Continue
Generic Forms Pres-free Frequency proprietary
Low viscosity
Hypromellose G 0.3%, 0.5% or 1% Available As required e.g. hourly Isopto plain
Isopto alkaline
Tears natural
Artelac SDU
Hydroxyl-ethylcellulose Minims 0.44% Yes As required Minims artificial tears
Polyvinyl alcohol G 1% or 1.4% Available As required Hypotears
Sno tears
Liquifilm
Liquifilm PF
Sodium chloride G 0.9%
Minims 0.9%
Available As required Minims saline
Medium viscosity
Carbomer 980 Gel 0.2% Available ≥4x/d Gel/tears
Liposic
Viscotears
Viscotears PF
Carmellose G 1% Yes ≥4x/d Celluvisc
High viscosity
Liquid paraffin Oc 30% or 42.5% Yes Nocte Lubri-tears
Lacri-lube
Yellow soft paraffin Oc 80% Yes Nocte Simple eye ointment

22. Astringent
Generic Forms Pres-free Frequency Proprietary
Acetylcysteine G 5% No 3-4x/d Ilube
TOPICAL TEAR REPLACEMENT

23. SYSTEMIC MEDICATION: GLAUCOMA Continue
• Systemic medication may be required to lower
intraocular pressure in the acute setting (e.g.
angle closure glaucoma) or if topical
treatment alone has failed. It is also
commonly used prophylactically post-
procedure (e.g. acetazolamide after cataract
surgery). Acetazolamide may also be used in
the treatment of raised intracranial pressure
secondary to idiopathic intracranial
hypertension.

24. Drug Dose Rout
e
Contraindications Side-effects
Acetazolamid
e
0.25-1g per
day in
divided doses
IV/PO Sulphonamide
allergy, salt
imbalance, renal
impairment, hepatic
impairment
Nausea, vomiting,
diarrhea,
paresthesia,
rashes, polyuria,
hypokalemia, salt
imbalance, mood
changes, blood
disorders
Mannitol 20% 1-2 g/kg over
45 mins
single dose
IV Cardiac failure Fluid overload
Fever
Glycerol 1g/kg in 50%
lemon juice
single dose
PO Diabetes mellitus hyperglycemia
SYSTEMIC MEDICATION: GLAUCOMA

25. SYSTEMIC CORTICOSTEROIDS: GENERAL
Continue..
Indications and mechanism
• In severe ophthalmic inflammation systemic
corticosteroids may be required.
Corticosteroids are anti-inflammatory but at
higher doses are immunosuppressive. The
immunosuppressive role of corticosteroids is
via inhibition of NF-kB transcription factor
signaling so blocking the production of IL-2
and other pro-inflammatory cytokines.

26. Routes of administration
• Oral: the preferred corticosteroid is usually prednisolone.
This may be started at 1mg/kg and then titrated down as
inflammation is controlled and/or steroid sparing agents
are added. Two forms are available: enteric and non-enteric
coated. The enteric-coated form is associated with fewer
upper gastrointestinal side-effects but its absorption may
be less predictable. It is best given in the morning
(coincides with physiological morning cortisol peak)
• Intravenous: the preferred corticosteroid is usually
methylprednisolone. This may be given as a single 500-
1000mg dose or ‘pulsed’ eg three doses of 500-1000 mg on
consecutive or alternate days given in a 100 ml of normal
saline over a minimum of 1h.
SYSTEMIC CORTICOSTEROIDS: GENERAL
Continue..

27. • Efficacy
SYSTEMIC CORTICOSTEROIDS: GENERAL
Continue..
Corticosteroids: equivalent anti-inflammatory
disorders
Prednisolone 5mg is equivalent to:
Dexamethasone 750µg
Betamethasone 750µg
Methylprednisolone 4mg
Triamcinolone 4mg
hydrocortisone 20mg

28. Contraindications
• Systemic infection (unless covered with appropriate antibiotics)
Monitoring
• Pre-treatment
• Due to the profound effects of corticosteroids a short pre-treatment
review is advised. This includes selected medical history (varicella status,
TB status, pre-existing diabetes/impaired glucose tolerance, hypertension)
and examine (weight, BP, glucose). If there is any possibility of TC, CXR
should be performed.
During treatment
• BP, weight, glucose every 3 months
• Lipids every 1 yr
• Bone density (DXA scan) if steroid course > 3 months; repeated scans may
be needed for monitoring bone density in at risk individuals
SYSTEMIC CORTICOSTEROIDS: GENERAL
Continue..

29. SYSTEMIC CORTICOSTEROIDS: GENERAL
Corticosteroid side-effects
Endocrine Adrenal suppression (risk of addisonian crisis with withdrawal), cushing’s
syndrome, weight gain, moon-face
Gastrointestinal Nausea, indigestion, peptic ulcer, pancreatitis
Musculo-skeletal Myopathy, osteopenia, osteoporosis, avascular necrosis
Skin Atrophy, bruising, stria, acne, hirusitism
Hematological Leukocytosis, immunosuppression
Biochemical Fluid/electrolyte disturbance
Psychiatric Mood disturbance, insomnia, psychosis
Neurological Increased ICP, papilledema, worsening of epilepsy
Cardiovascular Myocardial rupture after recent MI
Ophthalmic Increased IOP, posterior subcapsular cataracts, worsening of infection
(e.g. viral or fungal keratitis)

30. OTHER SYSTEMIC
IMMUNOSUPPRESSANTS Continue
Indications and mechanism
• Although corticosteroids are usually the drug of
choice in severe systemic or ocular inflammation,
other immunosuppressants have an important role
either as second-line agents in unresponsive cases or
in permitting reduction/withdrawal of corticosteroids
to minimize their side-effects.

31. Drug Dose Route Mechanism
Antimetabolite
Azathioprine
Methotrexate
Mycophenolate
50-150mg/d
7.5 mg/wk
1-2g/d
PO
PO/IM
PO
Antimetabolite: inhibits purine metabolism
Antimetabolite: inhibits dihydrofolatereductase
Antimetabolite: inhibits purine metabolism
Transcription factor inhibitors
Ciclosporin 2-5mg/kg/d PO NF-AT transcription factor inhibitor: inhibits IL-2
+other cytokines
Tacrolismus 0.1-0.3 mg/d PO NF-AT transcription factor inhibitor: inhibits IL-2 +
other cytokines
Cytotoxics
Cyclophosphamide 2-3 mg/kg/d PO/IV Alkylating agent: DNA cross-linking blocks cell
replication
Biologics
Infliximab
Etanercept
Interferon-α
3-5 mg/kg every 4-8
wks
25 mg twice per week
Depends on
preparation
IV
SC
SC/IV
Anti-TNF: chimeric antibody against TNF-α
Anti-TNF: Fc fusion protein which binds
extracellular TNF-α
Antiviral and anti-tumor: decreases NK cell
activity
OTHER SYSTEMIC
IMMUNOSUPPRESSANTS Continue

32. Cautions
• These immunosuppressive agents should, however
only be administered by someone with appropriate
experience in their use and with adequate
monitoring. Patients education is essential. This will
include the potential side-effects, necessary
precautions (e.g. contraception during and for a
period after taking most of these agents) and
warning symptoms which would require urgent
medical review.
OTHER SYSTEMIC
IMMUNOSUPPRESSANTS

33. IMMUNOSUPPRESSANTS AND
THEIR SIDE-EFFECTS Continue..
Drug Side-effects (selected) Suggested monitoring
Antimetabolites
Azathioprine Bone marrow suppression, GI upset,
secondary malignancies, alopecia
Pre-treatment: check TPMT levels (low levels
increase risk of bone marrow suppression) FBC
stat, weekly for 408 wks then at least every 3
months
Methotrexate Hepatotoxicity, bone marrow suppression, GI
upset
FBC, U+E, LFT stat, weekly until dose stable, then
every every 2-3 mths. Commonly folate (1mg/d or
5 mg/wk) is given concurrently
Mycophenolate Bone marrow suppression, GI upset,
secondary malignancies
FBC stat, weekly for 4 wks, then fortnightly for 8
wks, then monthly for first year
Transcription factor inhibitors
Ciclosporin Nephrotoxicity, hypertension, hepatotoxicity,
gingival hyperplasia, hypertrichosis
U+E. LFT, BP stat, fortnightly for 4 wks then every
4-6 wks
Tacrolismus Nephrotoxicity, hypertension, neurotoxicity,
hepatotoxicity
U+E, LFT, BP stat, fortnightly for 4 wks then every
4-6 wks

34. Cytotoxic
Cyclophosphamide Bone marrow suppression, hemorrhagic
cystitis, GI upset
Intensive specialist supervision required:
includes FBC (+ differential), LFT weekly for 4
wks then every 2-4 wks
Biologics
Infliximab Human antichimeric antibodies serum
sickness,tuberculosis reactivation
Pre-treatment: rule out TB infection
FBC (+ differential), U+E, LFT stat, for nightly
for 4 wks them every 4-6 wks
Etanercept Tuberculosis reactivation
Hypersensitivity reactions
Pre-treatment: rule out TB infection
FBC (+ differential), U+E, LFT stat, fortnightly
for 4 wks then every 4-6 wks
Interferon-α Leukopenia, depression, tuberculosis
reactivation, flu-like symptoms,
nephrotoxicity, hepatotoxicity
FBC (+ differential), U+E, LFT stat, fortnightly
for 4 wks then every 4-6 wks
Regular review of mental state
IMMUNOSUPPRESSANTS AND
THEIR SIDE-EFFECTS

35. RECOMMENDED DOSE AND PHARMACOLOGIC
PROFILE OF INTRAVITREAL ANTIBIOTICS Continue
Antibiotic Intravitreal dose (mg) Vitreous half-line (h)
Aminoglycosides
Amikacin 0.4 24
Gentamicin 0.2 12-35
Netilmicin 0.25 24
Tobramycin 0.2 16
Penicillins
Ampicillin 5 6
Carbenicillin 0.5-2 10-20
Methicillin 2 3-5
Oxacillin 5
Penicillin G 0.2-0.3 3
Piperacillin 1.5
Ticarcillin 3
Cephalosporins
Cefamandole 0.08 0.5
Cefazolin 0.5-2.0
Cefotaxime 0.4
Cefotetan 1
Ceftazidime 2 16
Ceftriaxone 2 12
Cephalexin
Cephaloridine 2.5
Cephalothin 2 2.4
Moxolactam 1.25-2.0 20

36. Fluoroquinolones
Ciprofloxacin 0.1 5
Garenoxacin 0.1-2
Gatifloxacin 0.4
Levofloxacin 0.625
Moxifloxacin 0.05-0.16 1.72
Ofloxacin 0.05 5.65
Pefloxacin 0.2
Travofloxacin 0.025
Macrolides
Erythromycin 0.5 30
Clarithromycin 1 2
Lincosamides
Lincomycin 1 7-8
Clindamycin 0.5-1
Carbapenems
Imipenem 0.5
Glycopeptides
Vancomycin 1 30
Teicoplanin 0.75
Miscellaneous
Aztreonam 0.1 7.5
Chloramphenicol 2 10
Cotrimoxazole 1.6
Doxycycline 1.125
Chloramphenicol 1
RECOMMENDED DOSE AND PHARMACOLOGIC
PROFILE OF INTRAVITREAL ANTIBIOTICS

37. NONTOXIC DOSES OF INTRAVITREAL
ANTIVIRAL DRUGS Continue
Drug Maximum non-toxic dose (µg)
Acyclovir 240
Ganciclovir 2000-5000
Vidarabine 100
Trifluorothymidine 200
6-methoxypurine arabinoside 400
Cidofovir 10-20
Ethyl deoxyuridine 200
Foscarnet 1000-2400
Interferons 640000 i.U.
Zinc gluconate 15
Papaverin 200
Verapamil 250
Etoposide 75

38. Combination of intravitreal antivirals
200µg/0.1 ml of trifluridine
400µg/0.1 ml of hydroxyacyclovir
200µg /0.1 ml of acyclovir
20µg/0.1 ml of vidarabine
Combination in vitrectomy infusion solutions
60µg/ml of trifluridine
20µg/ml of hydroxyacyclovir
40µg/ml of acyclovir
8µg/ml of vidarabine
NONTOXIC DOSES OF INTRAVITREAL
ANTIVIRAL DRUGS Continue

39. • Antifungals
Drug Intravitreal dose (mg) Vitreous half-life
polyenes
Amphotericin B 0.0005-0.01 6.9-15.1
Natamycin 3x0.025
Nystatin 200 U
Azoles
Fluconazole 0.1 3.1
Itraconazole 0.01
Ketoconazole 0.54
Miconazole 0.025-0.05 2
Oxiconazole 0.1
Terconazole 10
Voriconazole 0.05-0.1 2.5
NONTOXIC DOSES OF INTRAVITREAL
ANTIVIRAL DRUGS Continue

40. NONTOXIC DOSES OF INTRAVITREAL
ANTIVIRAL DRUGS Continue
Echinocandins
Capsofungin 0.1
Miscellaneous
Faerifungin 0.1
Flucytosine 0.1
Cilofungin 0.32
Topical antifungals Topical dose
Natamycin 5%
Amphotericin B 0.15%
Fluconazole 2%
Clotrimazole 1%
Miconazole 1%
Econazole 1%

41. NONTOXIC DOSES OF INTRAVITREAL
ANTINEOPLASTIC
Drug Maximum nontoxic doses (µg)
Bleomycinsulphate 15.0
Carboplatin 3.0
Cisplatin 0.1
Citarabine (are-C) 30.0
Dactinomycin 0.05
Doxorubicin 5.0
Etoposide(VP-16) 75.0
Mitomycin 2.0
Vincristine 0.04

42. NONTOXIC DOSES OF ANTINEOPLASTIC DRUGS
IN THE VITRECTOMY INFUSION FLUID
Drug Nontoxic level (µg/ml)
5-FU 230
Bleomycin 10
Carmustine (BCNU) 4
Cytarabin (ara-C) 1.2
Dactinomycin 0.02
Doxorubicin 5
Etoposide (VP-16) 80
Methotrexate 400
Mitomycin 0.8
Streptozocin 100
Thiotepa 8
Vincristine 0.02
Rituximab 0.1

43. NONTOXIC DOSES OF ANTINEOPLASTIC DRUG
COMBINATIONS IN INFUSION FLUID
Drug Concentration
(µg/ml)
5-FU (µg/ml)
Doxorubicin 5 250
Etoposide (VP-16) 40 250
Thiotepa 8 250
Vincristine 0.02 250