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Avastin (bevacizumab) for Retinopathy of Prematurity

Dosing

  • Lowest effective dose is not yet clear
  • at UIHC using 25mg/ml concentration (undiluted) and giving 0.25 mg in 0.01 ml

Ordering

  • bevacizumab 25mg/ml or 0.25mg per 0.01 ml
  • over fill to 0.11 ml
  • 30 unit Insulin syringe with 31 gauge/ 6mm needle

Syringe Delivery

Procedure

  • Coordinate with NICU staff for procedural sedation

Supplies

  • UIHC Eye Injection Pack
    • Includes plastic cup, cotton-tipped applicators, 4×4 gauze
  • Betadine 5% ampule
  • Tetrcaine or proparacaine drops
  • Lid specula (one per eye if desired)
  • Toothed forceps (0.12, 0.3 or Bishop Harman, one per eye if desired)
  • Sterile gloves
  • Facemask

Suggested Procedure Steps

  1. Tetracaine drops in both eyes
  2. Wipe around eyes and face with 4×4 gauze soaked in betadine
  3. Inspect syringe ensure plunger in proper location to deliver 0.01 ml (waste overfill)
  4. Place drops of betadine in eye especially in area for injection with soaked cotton tip applicator
  5. Grasp eye with toothed forceps to stabilize eye
  6. Hold syringe vertically and enter about 1 mm from limbus, aim posteriorly to avoid lens
  7. Slowly depress plunger and then when drug delivered, retract needle
  8. Place new betadine soaked cotton tip applicator over injection site and hold pressure for a few seconds.
  9. Repeat for fellow eye