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:

• Ocular implant (Iluvien): Intravitreal injection: One implant (0.19 mg) injected in affected eye.
• Note: Implant is designed to release fluocinolone at an initial rate of 0.25 mcg daily lasting 36 months.

Yutiq (Fluocinolone) treatment dose in chronic Uveitis:

• Ocular implant (Retisert): Intravitreal injection: One silicone-encased tablet (0.59 mg) surgically implanted into the posterior segment of the affected eye.
• Note: Implant is designed to initially release 0.6 mcg/day, decreasing over 30 days to a steady-state release rate of 0.3 to 0.4 mcg daily for 30 months.
• Reimplantation is required in case of recurrence of uveitis as it indicates the depletion of tablets.
• Ocular implant (Yutiq): Intravitreal injection: One implant (0.18 mg) injected in the affected eye.

Note: Implant is designed to release fluocinolone at an initial rate of 0.25 mcg daily lasting 36 months. [/bg_collapse]   [bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="Dose in Children" collapse_text="Dose in Children" ]

Fluocinolone (Yutiq) dose in children:

Yutiq treatment dose in chronic Uveitis:

• Children ≥12 years and Adolescents:

  • Ocular implant (Retisert): Intravitreal injection: One silicone-encased tablet (0.59 mg) surgically implanted into the posterior segment of the affected eye.
  • Note: Implant is designed to release 0.6 mcg/day, decreasing over 30 days to a steady-state release rate of 0.3 to 0.4 mcg daily for 30 months.
  • Reimplantation is required in case of recurrence of uveitis as it indicates the depletion of tablets.

Fluocinolone Pregnancy Risk Category: C

• Studies on animal reproduction showed adverse effects from the use of steroids. However, fluocinolone studies were not conducted.
• After ocular administration,systemic absorption is below the limit of quantification.

Fluocinolone use during breastfeeding:

• Breast milk contains systemic corticosteroids.
• The amount of fluocinolone that is absorbed by the eyes to make breast milk detectable is unknown. However, it is possible to determine the level of systemic absorption.
• Breastfeeding during therapy is a decision that depends on the risks to infants, the benefits to the mother, and the benefits to the infant.

Yutiq Dose adjustment in kidney disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Yutiq Dose adjustment in liver disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

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):

• Hypersensitivity to fluocinolone or other corticosteroids or any component of this formulation
• Iluvien onlyGlaucoma is a condition that occurs in patients with a cup-to-disc ratio of greater than 0.
• Viral diseases that are active in the cornea and conjunctiva include epithelial herpes complex keratitis (dendritic-keratitis), varicella, and vaccinia.
• Active bacterial, mycobacterial or fungal infections of your eye.

Warnings and precautions

• Formation of cataracts:

  • Corticosteroids can cause posterior subcapsular cataracts.

• Glaucoma:

  • Long-term steroids therapy can cause increased intraocular pressure and glaucoma. Glaucoma patients should be treated with caution
  • All patients should have their intraocular pressure checked.
  • Most patients will require intraocular pressure-lowering medication or filtering procedures within three years of implantation.

• Immunosuppression:

  • Fluocinolone may cause secondary bacterial, fungal or viral infections.
  • Patients with a history or potential for reactivation of ocular herpes are not advised to use it.
  • Patients who have had bacterial, fungal, fungal or viral infections should be cautious.
  • Steroids can mask acute purulent infections.
  • If you have persistent corneal ulceration, it is important to suspect fungal infection.

• Ocular effects

  • Intravitreal injections can cause increased intraocular pressure, inflammation, endophthalmitis and retinal detachment. Therefore, it is important to be vigilant.
  • In a few cases, an optic nerve injury may be visible.
  • There are some complications to the procedure, including cataract formation, hypotony and vitreous hemorhage.
  • Visual defects such as blurred vision or blurred field of sight may develop (lasting between 1 and 4 weeks after surgery).
  • Late-onset endophthalmitis may occur due to surgical site integrity.

• Ocular effects

  • Retisert: Perforation can result from topical steroids in the treatment of corneal or sclera diseases.
  • Steroids can help reduce the likelihood of bleb formation after cataract surgery.

Fluocinolone (topical): Drug Interaction

Monitoring parameters:

Iluvien, Yutiq:

• Monitoring of increased intraocular pressure and endophthalmitis is necessary after injection Optic nerve head perfusion should be checked immediately after injection, tonometry within 30 minutes, and biomicroscopy between 2 to 7 days after injection.

Retisert:

• Monitoring the integrity of implant by visual inspection is required, recurrence of uveitis, intraocular pressure should be checked periodically.

How to administer Fluocinolone (Yutiq)?

Ophthalmic implant (intravitreal injection):

• It should be administered under controlled aseptic conditions (eg, sterile gloves, sterile drape, sterile eyelid speculum).
• Adequate anesthesia and a broad-spectrum bactericidal should be given to the periocular skin, eyelid, and ocular surfaces before injection.
• Refer to manufacturer’s prescribing information for administration technique.

Iluvien:

• Preloaded applicators should be inspected visually to ensure the presence of a drug implant. Optimal placement is inferior to the optic disc and posterior to the equator of the eye.

Retisert:

• In order to avoid damage to the tablet integrity and adversely affecting release characteristics, it should only be handled by a suture tab.
• Resterilization should be avoided.

Yutiq:

• Optimal placement is inferior to the optic disc and posterior to the equator of the eye.

Mechanism of action of Fluocinolone (Yutiq):

• Fluocinolone inhibits phospholipase A2 through lipocortin stimulation. 
• Lipocortins cause inhibition of arachidonic acids, which in turn controls the biosynthesis prostaglandins (leukotrienes) and prostaglandins (leukotrienes). 
• Arachidonic acid can be released by membrane phospholipids via phospholipase B2.

Duration:

• Iluvien, Yutiq:Fluocinolone Acetonide is released at an initial rate 0.25 mcg/day over 36 months.
• Retisert:Fluocinolone Acetonide is released at an initial rate 0.6 mcg/day. This rate decreases over 30 days to a steady rate of 0.3-0.4 mcg/day after 30 months.

Absorption:

• Systemic absorption is negligible.

Distribution:

• Retisert: Aqueous and vitreous humor.

International Brands of Fluocinolone:

• Iluvien
• Retisert
• Yutiq

Fluocinolone  Brand Names in Pakistan:

No Brands Available in Pakistan.