Fluocinolone is a corticosteroid that is sometimes used in ophthalmic (eye-related) medications. Corticosteroids have anti-inflammatory properties and are often employed to reduce inflammation and treat various eye conditions. These conditions may include inflammation of the conjunctiva (conjunctivitis), uveitis, and other inflammatory eye disorders.

The ophthalmic form of fluocinolone is typically administered as eye drops or ointment. It's important to note that the use of any medication, especially those related to the eyes, should be prescribed and supervised by a qualified healthcare professional, usually an ophthalmologist. Using eye medications without proper medical guidance can lead to complications and may exacerbate underlying issues.

Yutiq (Fluocinolone acetonide) is a non-bio-erodible intravitreal implant that is indicated in the management of chronic non-infectious posterior uveitis.

Indications of Fluocinolone (Yutiq):

• Diabetic macular edema (Iluvien):
  • It is indicated for treating diabetic macular edema in patients who have been previously treated with a course of corticosteroids and without any clinically significant rise in intraocular pressure.
• Uveitis (Retisert, Yutiq):

It is useful in the management of chronic, noninfectious uveitis affecting the posterior segment of the eye.

Fluocinolone dose in adults:

Yutiq (Fluocinolone) treatment dose in Diabetic macular edema:

• For diabetic macular edema, there's a treatment using an eye implant called Iluvien.
• This implant is given as a shot directly into the eye (intravitreal injection).
• One implant, containing 0.19 milligrams of a substance called fluocinolone, is injected into the eye that's affected.
• The special thing about this implant is that it's designed to release fluocinolone slowly over time.
• It starts with 0.25 micrograms every day, and this slow release lasts for 36 months (about 3 years).

Yutiq (Fluocinolone) treatment dose in chronic Uveitis:

For chronic uveitis, there are two types of eye implants - Retisert and Yutiq:

• Retisert (Ocular Implant):
  • Procedure: It involves a surgery where a small tablet (0.59 mg) encased in silicone is implanted into the back part of the affected eye.
  • Release: Initially, it releases 0.6 micrograms of a substance called fluocinolone per day. Over the first 30 days, this decreases to a steady release of 0.3 to 0.4 micrograms daily.
  • Duration: This steady release lasts for 30 months. If uveitis comes back, it means the tablet is used up, and another implant is needed.
• Yutiq (Ocular Implant):
  • Procedure: It's given as an injection directly into the affected eye.
  • Release: The implant is designed to release fluocinolone at an initial rate of 0.25 micrograms per day.
  • Duration: This slow release continues for 36 months (about 3 years).

Both of these implants are designed to gradually release fluocinolone to help manage chronic uveitis over an extended period. If uveitis comes back, it may indicate that the medication in the Retisert implant is depleted, requiring another implant.

Fluocinolone (Yutiq) dose in children:

Yutiq treatment dose in chronic Uveitis:

for the treatment of chronic uveitis in children aged 12 years and above:

Medication: Retisert (Ocular Implant)

Administration: It involves a surgical procedure where a small tablet (0.59 mg) encased in silicone is implanted into the back part of the affected eye.

Dosage and Release:

• Initial Release: The tablet is designed to release 0.6 micrograms of fluocinolone per day.
• Decrease: Over the first 30 days, this release gradually decreases.
• Steady-State: After 30 days, it reaches a steady release rate of 0.3 to 0.4 micrograms daily.

Duration: This steady release continues for 30 months. If uveitis comes back, it means the tablet is used up, and another implant is needed.

Fluocinolone Pregnancy Risk Category: C

• This medicine hasn't been tested on animals, but in studies with other corticosteroids, some negative effects were seen in animal pregnancies.
• When you put this medicine in your eyes, not much of it gets into the rest of your body.

Fluocinolone use during breastfeeding:

• Corticosteroids, like the one in this medicine, can be found in breast milk.
• However, it's unclear if using this specific fluocinolone medicine in your eyes results in enough absorption to detect it in breast milk.
• Even though there's minimal absorption into the body, the decision to breastfeed while using this treatment should carefully weigh the potential risk to the baby, the advantages of breastfeeding for the baby, and the benefits of the treatment for the mother.

Yutiq Dose adjustment in kidney disease:

• The information from the company that makes the medicine doesn't suggest changing the dose for people with kidney problems.

Yutiq Dose adjustment in liver disease:

• The instructions from the company that makes the medicine don't recommend changing the dose for people with liver problems.

Common Side Effects of Fluocinolone (Yutiq):

• Central Nervous System:
  • Headache
  • Dizziness
• Dermatologic:
  • Skin Rash
• Gastrointestinal:
  • Nausea
  • Vomiting
• Hematologic & Oncologic:
  • Anemia
• Infection:
  • Influenza
• Neuromuscular & Skeletal:
  • Back Pain
  • Limb Pain
  • Arthralgia
• Ophthalmic:
  • Cataract
  • Increased Intraocular Pressure
  • Eye Pain
  • Abnormal Sensation In Eyes
  • Blepharoptosis
  • Blurred Vision
  • Decreased Visual Acuity
  • Eyelid Edema
  • Macular Edema
  • Maculopathy
  • Visual Disturbance
  • Conjunctival Hemorrhage
  • Decreased Intraocular Pressure
  • Dry Eye Syndrome
  • Eye Pruritus
  • Vitreous Opacity
  • Conjunctival Hyperemia
  • Glaucoma
  • Vitreous Hemorrhage
  • Eye Irritation
  • Lacrimation
• Respiratory:
  • Cough
  • Nasopharyngitis
  • Sinusitis
  • Upper Respiratory Tract Infection
• Miscellaneous:
  • Procedural Complications
  • Fever

Rare Side Effects of Fluocinolone (Yutiq):

• Cardiovascular:
  • Hypertension
• Central Nervous System:
  • Foreign Body Sensation Of Eye
• Ophthalmic:
  • Uveitis
  • Anterior Chamber Eye Hemorrhage
  • Blepharitis
  • Choroidal Detachment
  • Diplopia
  • Retinal Detachment
  • Retinal Hemorrhage
  • Swelling Of Eye
  • Synechiae Of Iris
  • Corneal Edema
  • Posterior Capsule Opacification
  • Eye Discharge
  • Photophobia
  • Photopsia
  • Anterior Chamber Inflammation
  • Conjunctivitis
  • Ocular Hyperemia
  • Ophthalmic Inflammation
  • Vitreous Disorder
  • Eye Discomfort
  • Hypopyon
  • Optic Atrophy
  • Retinal Exudates
  • Retinopathy
  • Chorioretinitis
  • Iridocyclitis
  • Visual Field Defect
• Renal:
  • Renal Failure
• Respiratory:
  • Pneumonia

Contraindications to Fluocinolone (Yutiq):

• This medicine should not be used by people who are highly sensitive or allergic to fluocinolone, other corticosteroids, or any part of the medicine.
• It's also not recommended for those with ongoing or suspected eye infections, especially viral infections like herpes simplex, vaccinia, and varicella, as well as active bacterial, mycobacterial, or fungal eye infections.
• Specifically, for Iluvien, it is not suitable for individuals with glaucoma if they have certain ratios in their eyes.

Warnings and precautions

Formation of cataracts:

• The use of corticosteroids, like the one in this medication, might lead to the development of a type of cataract called posterior subcapsular cataract.
• This is a condition where the lens at the back of the eye becomes cloudy.

Glaucoma:

• Using corticosteroids, especially for a long time, can increase pressure inside the eye, leading to a condition called glaucoma.
• If you have glaucoma or are at risk, be cautious when using this medication.

Immunosuppression:

• This medication may weaken the immune system, making it easier to get additional bacterial, fungal, or viral infections.
• It's not advised for those with a history of ocular herpes simplex because it might cause a reactivation.
• Be cautious if you have a history of bacterial, mycobacterial, fungal, or viral infections in the eyes.
• In some cases, especially with fungal and viral infections, this medicine could mask the signs of infection, making it harder to notice.
• If there's ongoing damage to the cornea (the front part of the eye), it's essential to consider the possibility of a fungal infection.

Ocular effects

• Injections directly into the eye (intravitreal injections) can have various effects on the eyes, such as the risk of serious conditions like eye inflammation, increased pressure inside the eye, and detachment of the retina.
• Close monitoring is crucial after such injections.
• Complications may include the development of cataracts, detachment of the choroid (a part of the eye), low eye pressure, bleeding within the eye, loss of the vitreous gel, and the opening of the surgical wound.
• There's also a potential for optic nerve injury during the procedure.
• Temporary visual issues, like changes in sharpness and field of vision, may happen for a few weeks after the injection.
• Additionally, late-onset endophthalmitis, often linked to the integrity of the surgical site, has been observed.

Ocular effects

• When using Retisert, there's a risk of the eye's outer layers (cornea or sclera) thinning, and perforation (a hole) may occur, especially in conditions that make these layers thinner.
• The use of steroids like those in Retisert might also slow down the healing process after cataract surgery and increase the likelihood of bleb formation.

Monitoring parameters:

Iluvien and Yutiq:

• After Injection Monitoring: Keep an eye out for increased pressure inside the eye and the risk of endophthalmitis (eye infection).
• Immediate Checks: Right after the injection, it's important to check the optic nerve head's blood supply, measure eye pressure within 30 minutes, and conduct a detailed eye examination between 2 to 7 days post-injection.

Retisert:

• Implant Integrity: Periodically inspect the implant to make sure it's intact.
• Recurrence of Uveitis: Watch for the return of uveitis symptoms, as it might suggest the need for another implant.
• Eye Pressure (IOP): Keep an eye on the intraocular pressure (pressure inside the eye).

How to administer Fluocinolone (Yutiq)?

Administering Ophthalmic Implant (Intravitreal Injection):

• Aseptic Conditions: Use sterile equipment such as gloves, drapes, and eyelid speculum to maintain cleanliness.
• Anesthesia and Antiseptic: Apply proper anesthesia and a broad-spectrum bactericidal solution to the skin around the eye, the eyelid, and the eye surface before the injection.
• Administration Technique: Follow the specific guidelines provided by the manufacturer for the correct administration method.

Iluvien:

• Visual Inspection: Check the preloaded applicator visually to ensure it contains the drug implant.
• Optimal Placement: The best position for the implant is below the optic disc and towards the back of the eye.

Retisert:

• Handling Instructions: Hold the implant only by the suture tab to avoid damaging the tablet's integrity and affecting its release characteristics.
• Sterilization Warning: Do not attempt to resterilize the implant.

Yutiq:

• Optimal Placement: Like Iluvien, the recommended position for the implant is below the optic disc and towards the back of the eye.

Mechanism of action of Fluocinolone (Yutiq):

• This medicine works by stopping a process called phospholipase A through the induction of lipocortin.
• Lipocortin helps in controlling the creation of substances like prostaglandins and leukotrienes by blocking arachidonic acid.
• This acid is released from membrane phospholipids when acted upon by phospholipase A.
• Essentially, by inhibiting this specific enzyme, the medication helps regulate the production of certain substances in the body.

Duration of Action:

• Iluvien, Yutiq: These implants release fluocinolone acetonide initially at a rate of 0.25 micrograms per day, and this continues for 36 months (about 3 years).
• Retisert: The release of fluocinolone acetonide begins at 0.6 micrograms per day, decreasing over the first 30 days to a stable release rate of 0.3 to 0.4 micrograms per day, maintaining this level for 30 months.

Absorption and Distribution:

• Systemic Absorption: For all these implants, the amount of the medication that gets into the overall bloodstream is very minimal.
• Retisert Distribution: The Retisert implant is distributed in the aqueous humor and vitreous humor, which are fluids within the eye.

International Brands of Fluocinolone:

• Iluvien
• Retisert
• Yutiq

Fluocinolone Brand Names in Pakistan:

Not available.