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11.4 CORTICOSTEROIDS AND OTHER ANTI-INFLAMMATORY PREPARATIONS

11.4 CORTICOSTEROIDS AND OTHER ANTI-INFLAMMATORY PREPARATIONS

11.4 CORTICOSTEROIDS AND OTHER ANTI-INFLAMMATORY PREPARATIONS
         11.4.1 Corticosteroids   
             Topical corticosteroids should normally only be used with expert supervision
                    GREEN      Betamethasone eye/ear/nose drops 0.1%
                    GREEN      Betnesol-N® eye/ear/nose drops
                    GREEN      Dexamethasone eye drops 0.1 (Maxidex®)
                    GREEN      Fluorometholone eye drops 0.1%
                    GREEN      Maxitrol® eye drops, eye ointment 
                    GREEN      Prednisolone eye/ear drops 0.5%
                    GREEN      Predsol-N® eye/ear drops
                    AMBER     Prednisolone eye drops 1% (forte)(specialist use only)
 
              For the treatment of post operative inflammation following ocular surgery in patients  who are at risk of corticosteroid 
              induced raised intra-ocular pressure.
                    AMBER     Loteprednol drops 0.5% (specialist use only) 
                    RED           Dexamethasone intravitreal implant 700mcg (specialist use only) 
                     (For further information, see NICE TA229) 
 
              NICE Guidance for the treatment of sight problems caused by diabetic macular oedema 
                 NICE TA824* Dexamethasone intravitreal implant is recommended as an option for treating visual impairment caused by
                                       diabetic macular oedema in adults only if their condition has not responded well enough to, or if they
                                       cannot have non-corticosteroid therapy. See full guidance
                                       *NICE TA824 updates and replaces NICE TA349 (September 2022(
                                           
                    RED           Dexamethasone intravitreal implant 700mcg (specialist use only)            ICS Commissioned, Blueteq required            
 
              
              NICE guidance for treating chronic diabetic macular oedema after an inadequate response to prior therapy
                   NICE TA301* Fluocinolone acetonide intravitreal implant is recommended as an option for treating chronic diabetic
                                         macular oedema that is insufficiently responsive to available therapies only if:
                                           >  the implant is to be used in an eye with an intraocular (pseudophakic) lens and 
                                           >  the manufacturer provides fluocinolone acetonide intravitreal implant with the discount agreed in the 
                                               patient access scheme.
                   *[Rapid review of NICE TA271] 
                   RED Fluocinolone acetonide intravitreal implant (Iluvien®)                                                    NHS England Commissioned 
 
                NICE guidance for treating visual impairment due to diabetic macular oedema in adults
                   NICE TA799   Faricimab  is recommended as an option for treating visual impairment due to diabetic macular oedema
                                          in adults, only if:
                                             > the eye has a central retinal thickness of 400 micrometres or more at the start of treatment
                                             > the company provides faricimab according to the commercial arrangement
                    RED              Faricimab (Vabysmo solution for injection vials)               ICB Commissioned [formerly CCG]. Blueteq required
 
              NICE guidance for treating non-infectious uveitis in adults  
                  NICE TA460  Adalimumab is recommended as an option for treating non-infectious uveitis in the posterior segment
                                       of the eye in adults with inadequate response to corticosteroids, only if there is:
                                         >  active disease (that is, current inflammation in the eye) and
                                         >  inadequate response or intolerance to immunosuppressants and
                                         >  systemic disease or both eyes are affected (or 1 eye is affected if the second eye has poor visual acuity) 
                                             and
                                         >  worsening vision with a high risk of blindness (for example, risk of blindness that is similar to that seen in
                                             people with macular oedema).
                                       Dexamethasone intravitreal implant is recommended as an option for treating non-infectious uveitis in the 
                                       posterior segment of the eye in adults, only if there is:
                                         >  active disease (that is, current inflammation in the eye) and
                                         >  worsening vision with a risk of blindness.
                   RED           Adalimumab solution for injection                                                                        NHS England Commissioned
                   RED           Dexamethasone intravitreal implant 700mcg (specialist use only)                   NHS England Commissioned
 
              NICE guidance for treating non-infectious uveitis 
                  NICE TA590  Fluocinolone acetonide intravitreal implant is recommended as an option for preventing relapse in
                                       recurrent non-infectious uveitis affecting posterior segment of the eye. It is recommended only if the 
                                       company provides it according  to the commercial arrangement.  
                   RED Fluocinolone acetonide intravitreal implant (Iluvien®)                                                       NHS England Commissioned 
                                                                                                
              Dexamethasone intravitreal implant 700mcg [Ozurdex®]
              Approved as second line treatment when there is no significant effectiveness and response of the diabetic macular 
              oedema to previous Anti VEGF 
                     
                    RED         Dexamethasone intravitreal implant 700mcg (specialist use only)    [Ozurdex®]
                                                                                                                                                          CCG Commissioned Blueteq form required
         11.4.2 Other anti-inflammatory preparations 
               Used to treat inflammation and allergic conjunctivitis
                     GREEN      Sodium cromoglicate eye drops 2% (1st line option)
                     GREEN      Otrivine-Antistin® eye drops 
 
                     Seasonal Allergic Conjunctivitis
                     GREEN      Olopatadine eye drops 1mg/ml   [maximum use 4 months]
                     restricted 
                     (Consultant initiation only2nd line option, when first line of management fails or not adequate
                     GREEN       Ketotifen UDV eye drops 0.25mg/ml PF [Ketofall®]
                     restricted    (option when preservative free product is required)
 
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