First Author: H.Vannadil INDIA
Co Author(s): K. Shahare A. Prabhakara M. A. Khan
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Avastin (Bevacizumab) is a cheaper alternative to the anti VEGF drug Ranibizumab. In India, a vast majority of patients are unable to afford Inj Ranibizumab due to the high costs. Due to the lower costs, many centres in India use Inj Avastin off label for such patients. There has been incidents of infective and non-infective endophthalmitis at various centers. Our centre has been using Avastin for past 07 and has maintained it incident free for past 07 years. We believe that our method of delivering Inj Avastin to patients has a role to play in this track record.
A Govt funded tertiary eye care centre catering to approx 15 to 20 intravitreal bevacizumab injections weekly. The drug, Bevacizumab, is supplied by the Govt sources to our hospital. Inj Bevacizumab is not approved for intraocular use.
The drug is drawn in multiple sterile 01ml tuberculin syringes under strict asepsis in the operating room (0.1 ml each), capped by sterile 26 gauge needle and sealed inside pre sterilised (ETO) zip pouches (one in each pouch), which are in turn placed inside sterile drum with double layer of sterile drape. The drum is refrigerated at 04 degree C with date of preparation marked. One sample sent for culture. Drug used only after sample is culture negative. The pouches removed under sterile precautions as per need and injected after changing needle with all standard precautions.
The method has kept our center incident free for past 07 years and delivering more than 6000 intravitreal Avastin (bevacizumab) injections. One lot of Inj Avastin with 24 doses were discarded after the culture report shows gram positive cocci in the report preventing 24 potential infective endophthalmitis.
Inj Avastin is a viable cost effective alternative to Inj Lucentis (Ranibizumab) for the economically challenged patient population. the delivery of the drug can be maintained incident free if necessary precautions are taken. Microbial culture before using the drug has proven beneficial in this case at our center and the same is replicable at various centers for a better outcome.