Preparations can contain a single drug or a combination in the most appropriate strength and concentration for a specific use, such as fortified antibiotic or pre-op drops.

Examples of preservative-free preparations include drops or sprays containing the following medications, alone or in combination:

We use only the highest quality ingredients from an FDA registered supplier. Ask us about medications that are commercially unavailable or have been discontinued (for reasons other than safety concerns). We welcome the opportunity to answer your questions, and to work with you to compound medications that meet the specific needs of your practice. Please contact our compounding pharmacist with questions or to discuss any unique needs.

Autologous Serum Eye Drops
 
Conventional treatment of dry eye mainly consists of the use of preservative-free artificial eye drops and punctal occlusion. None of the commercially available artificial tear preparations include essential tear components such as epidermal growth factor, hepatocyte growth factor, fibronectin, neurotrophic growth factor, and vitamin A - all of which have been shown to play important roles in the maintenance of a healthy ocular surface epithelial milieu. Autologous serum (AS) eye drops contain these essential factors and are beneficial in the treatment of ocular surface diseases such as persistent epithelial defects (PED), superior limbic keratoconjunctivitis, keratoconjunctivitis sicca, and neurotrophic keratopathy. AS treatment has been demonstrated to be more effective than artificial tears in a randomized control study. In in vivo and in vitro experiments, AS eye drops showed marked suppression of apoptosis in the conjunctival and corneal epithelium. Albumin, the major protein in serum, improved ocular surface damage in vivo and rescued apoptosis after serum deprivation in vitro.
 
Autologous serum eye drops are non-allergenic and their biomechanical and biochemical properties are similar to normal tears. The protocol by Tsubota and associates entails obtaining a total of 40 ml of blood by venopuncture and centrifuging for 5 minutes at 1,500 rpm. The serum is then carefully separated in a sterile manner and diluted with sterile saline (preservative free) to prepare 20-50% autologous serum drops. Typically, aliquots of the final preparation are prepared in 5 ml vials with ultraviolet light protection, because vitamin A is easily degraded by light. Patients are instructed to keep the vials they are using in a refrigerator at 4 C and to store the other vials in a freezer until needed.
 

In the study by Kojima et al., none of the patients had punctal occlusion, which allowed evaluation of the solitary effect of autologous serum drops. They found significant improvements in tear stability, ocular surface vital staining scores, and pain symptom scores in patients treated with autologous serum eyedrops compared with those assigned to nonpreserved artificial tears; and concluded that autologous serum is superior to conventional treatment with artificial tears for improving ocular surface health and subjective comfort.

 Am J Ophthalmol. 2005 Feb;139(2):242-6
The effect of autologous serum eyedrops in the treatment of severe dry eye disease: a prospective randomized case-control study.
Click here to access the PubMed abstract of this article.

Locally applied acetylcysteine, a mucolytic, regulates mucus secretion and reduces mucus accumulation, and has an antiproliferative effect on keratinocytes. Therapy with acetylcysteine ophthalmic has proved more efficient than artificial tears in reducing subjective symptoms of dry eye syndrome. The advantages of acetylcysteine include more convenient instillation timing (4 times daily) and reduced nocturnal discomfort.

Acta Med Croatica. 2005;59(4):337-40.
[Comparison of local acetylcysteine and artificial tears in the management of dry eye syndrome].
[Article in Croatian]
Pokupec et al.
Click here to access the PubMed abstract of this article.

The efficacy of topical N-acetyl-cysteine (NAC) therapy was evaluated in patients with meibomian gland dysfunction (MGD). One month of topical NAC 5% (four times daily) provided statistically significant improvements in fluorescein break-up time (FBUT) values and Schirmer scores as compared with preservative-free artificial tears. Significant improvements for the symptoms of ocular burning, foreign body sensation, and intermittent filmy or blurred vision were noted in both groups; and only the NAC-treated group showed improvement for the symptom of itching. Conclusions: Topical administration of NAC is thought to be effective and well tolerated in patients with MGD.

J Ocul Pharmacol Ther. 2010 Jul 24. [Epub ahead of print]

Intravitreal Bevacizumab for Neovascular AMD

Bevacizumab (Avastin™) is derived from the same monoclonal antibody precursor as ranibizumab (Lucentis™), yet bevacizumab costs considerably less than ranibizumab when administered as an intravitreal injection. Results of triple therapy using bevacizumab and intravitreal injections of dexamethasone or triamcinolone in combination with photodynamic therapy are encouraging.

N Engl J Med. October 5, 2006; 355(14):1409-1412

Acta Ophthalmol. 2010 Aug;88(5):594-600. Epub 2009 May 22.
Effect of intravitreal bevacizumab (Avastin) in neovascular age-related macular degeneration using a treatment regimen based on optical coherence tomography: 6- and 12-month results.
Leydolt C et al.
Click here to access the PubMed abstract of this article.

Retina. 2008 Oct;28(9):1325-37.
Long-term safety and efficacy of intravitreal bevacizumab (Avastin) for the management of central retinal vein occlusion.
Gregori et al.
Click here to access the PubMed abstract of this article.

Ophthalmic Surg Lasers Imaging. 2009 May-Jun;40(3):293-5.
Sustained elevation in intraocular pressure associated with intravitreal bevacizumab injections.
Kahook et al.
Click here to access the PubMed abstract of this article.

Retina. 2009 May;29(5):573-8.
Same-day triple therapy with photodynamic therapy, intravitreal dexamethasone, and bevacizumab in wet age-related macular degeneration.
Bakri SJ, Couch SM, McCannel CA, Edwards AO.
Click here to access the PubMed abstract of this article.

Acta Ophthalmol. 2010 Aug;88(5):558-63. Epub 2009 Apr 27.
Macular function after intravitreal triamcinolone acetonide injection for diabetic macular oedema.
Karacorlu M, Ozdemir H, Senturk F, Karacorlu SA, Uysal O.
Click here to access the PubMed abstract of this article.

Cycloplegic (Mydriatic) Eye Spray

Children often resist instillation of mydriatic drops for dilated fundus evaluation. As cycloplegic sprays have proven useful, two studies in children aged 3-13 years, compared administration of one drop each of 1% tropicamide and 2.5% phenylephrine in each eye or one application of mydriatic spray (containing concentrations of 0.5% tropicamide and 2.5% phenylephrine) to each closed eyelid. These studies indicate that use of mydriatic sprays on closed eyelids is as efficacious as use of mydriatic drops in open eyes, and is a preferred method of administration for children.

Because mydriatic sprays are compounded, the physician has flexibility in prescribing the concentration and combinations of medications, and may also include homatropine, scopolamine or proparacaine.

Optom Vis Sci. 1997 Mar;74(3):160-3.
Efficacy of a mydriatic spray in the pediatric population.
Click here to access the PubMed abstract.

Binocul Vis Strabismus Q. 1999;14(2):107-10
A randomized comparison study of drop versus spray topical cycloplegic application.
Click here to access the PubMed abstract.

Another study compared the tolerance and efficacy of cyclopentolate spray versus drops in 62 eyes of 32 children. The nonparametric Wilcoxon test for paired data showed no significant difference between cycloplegic measurements with drops or spray. The report concluded that cyclopentolate spray is a good alternative to traditional drops, leading to equal cycloplegic efficacy but greater tolerance in children. The spray was also easier to administer.

J Fr Ophtalmol. 2006 Oct;29(8):896-9.

Comparative study of cyclopentolate drops versus spray in cycloplegia in children.
[Article in French]

Chafai A, Ajdnik S, Lejeune L, Cordonnier M.

Click here to access the PubMed abstract.

Many procedures call for multiple eye drops administered in a short period of time. The problem is that consecutive drops wash out and dilute the preceding medication, causing decreased effectiveness and repeated administration. While some clinics will mix all of the drops together (slurry) before administration, this results in a significant dilution of active ingredients from their therapeutic concentration. We can prepare combination eye drops that maintain the original therapeutic concentration in each drop. In addition, the viscosity can be increased to maintain tissue contact time. Other benefits include simplified administration, reduced staff time (fewer drops), improved accuracy and less waste.