Ocular diagnostic and peri-operative preparations and photodynamic treatment
Ocular diagnostic preparations
Dye (Unlicensed product)- NUH only For use as a dye in the intraoperative staining of internal membrane during macular hole surgey
Specialist use only Injection 10%: - for fluorescein angiography of the ocular fundus - for use as a contrast media for confocal laser endomicroscopy (CLE)(Unlicensed indication) Injection 20% (Unlicensed Product)
Eye drops 2% (preservative free Minims®)
Diagnostic use only
Bio Glo 1mg ophthalmic strips have been discontinued
Available at NUH:
Ophthalmology use for angiography.
Neurosurgery use for angiography.
Gynaecological surgery by intracervical injection for detection of sentinel lymph nodes.
N.B. AKORN brand injection no longer used at NUH for intravitreal use
At SFH: Miphtel® available until the Miochol becomes available again.
Eye drops 0.5% Eye drops 1% (preservative free)
Specialist recommendation only for treatment of chronic glaucoma.
The 1% preservative free version is very expensive (£6.50 per 'single use' bottle.) Only for patients with a known preservative allergy, known ocular surface disease or those with raised intraocular pressure despite treatment with 0.5% drops. Short term post operative use is classified RED.
Ketorolac (Acular®) (Eye)
Eye drops 0.5% 5ml. Preserved. (~£3)
Amber 2 specialist initiation - adult ocular surgery patients post-operatively
- Eye drops 0.1% single use (preservative free) only (~£30 for 40) - Eye drops 0.1% multidose (~£7)(preserved) replaced by ketorolac (~£3) eye drops March 2013. Dec 18: Formulary again while ketorolac unavailable (until March 2019).
Pre-filled syringe 3.6mg in 0.09mL (Each pre-filled syringe contains 3.6mg in 0.09mL solution - this contains a usable amount to deliver a dose of 2mg in 0.05ml i.e. treatment for 1 eye. If the patient is having 2 eyes treated, 2 syringes must be used) Intravitreal injection 40mg in 1mL - Discontinued 2020 (Each vial contains 4mg in 0.1ml solution- this contains a usable amount to deliver a dose of 2mg in 0.05ml i.e. treatment for 1 eye. If the patient is having 2 eyes treated, 2 vials must be used)
Available for use at NUH and SFH in line with NICE for: - Age-related Macular Degeneration (AMD) NICE TA294 - Visual impairment due to macular oedema secondary to central retinal vein occlusion (CRVO) NICE TA305 - Diabetic Macular Oedema NICE TA346 - NUH only - Visual impairment in adults caused by macular oedema after branch retinal vein occlusion (BRVO) NICE TA409 - NUH only - Treating choroidal neovascularization NICE TA486
NUH only Intravitreal injection (Unlicensed Product) 1.25mg in 0.05mL or 625micrograms in 0.025mL Restricted for; 1. age related macular degeneration 2. Diabetic maculopathy and/or proliferative diabetic retinopathy, unresponsive to conventional treatments such as laser, vitrectomy or intravitreal Triamcinolone 3. Retinal vein occlusions 4. Retinopathy of prematurity only where treatment is required and laser is not a suitable option
Intravitreal injection 10mg in 1mL (Each vial contains 2.3 mg of ranibizumab in 0.23 ml solution) (NUH:Each pre-filled syringe contains 1.65 mg of ranibizumab in 0.165 ml solution)
Available for use at NUH and SFH in line with NICE for: - Age-related Macular Degeneration (AMD) NICE TA155 - Diabetic Macular Oedema (DMO) NICE TA274 - Macular Oedema secondary to Retinal Vein Occlusion (RVO) NICE TA283 - Choroidal neovascularisation associated with pathological myopia NICE TA298
Intravitreal injection - now supplied as a 'ready-diluted' formulation (Each vial contains 0.375 mg of ocriplasmin in 0.3 mL solution (1.25 mg/mL). This provides a usable amount to deliver a single dose of 0.1 mL containing 0.125 mg ocriplasmin.) NUH approved in accordance with NICE TA297 for use by ophthalmology for treating vitreomacular traction in adults. Not to be used at SFH (patients would be referred to a speciallist centre). NUH prescribing will be undertaken within the ophthalmology department and will be a two consultant decision.
Grey / Non-Formulary: Medicines, which the Nottinghamshire APC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data. Grey / Non-Formulary (undergoing assessment): Work is ongoing and will be reviewed at a future APC meeting. Grey / Non-Formulary (no formal assessment): APC has not formally reviewed this medicine or indication because it had never been requested for formulary inclusion. Often used for drugs new to market.
Medicines which should normally be prescribed by specialists only. eg hospital only.
For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.
Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised.
Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the Nottinghamshire APC.
Medicines suitable to be prescribed in primary care / general practice after specialist* recommendation or initiation.
A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust DTCs and approved by the Nottinghamshire APC.
*Specialist is defined by the APC as a clinician who has undertaken an appropriate formal qualification or recognised training programme within the described area of practice
Primary care/ non specialist may initiate as per APC guideline.
The supporting prescribing guideline must have been agreed by the relevant secondary care trust D&TC(s) and approved by the Nottinghamshire APC.
Medicines suitable for routine use within primary care.
Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.