Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Review Ophthalmic Res 2010;44:205–224 DOI: 10.1159/000316695 Retinal and Ocular Toxicity in Ocular Application of Drugs and Chemicals – Part II: Retinal Toxicity of Current and New Drugs Fernando Marcondes Penha Eduardo B. Rodrigues Maurício Maia Bruno A. Furlani Caio Regatieri Gustavo B. Melo Octaviano Magalhães, Jr. Roberta Manzano Michel E. Farah Vision Institute, Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil fied and discussed. Results: Corticosteroids like fluocino- lone, dexamethasone or triamcinolone at low dose cause little damage to the retina, but at high doses signs of toxicity have been well documented. Complications like cataract and glaucoma are quite common with corticosteroids. Ami- noglycosides showed differences in the type and doses as- sociated with toxic reactions, thereby the following order of toxicity can be described (from most toxic to least toxic): gentamicin 1 netilmicin = tobramycin 1 amikacin = kanamy- cin. Vancomycin at the usual dose of 1 mg is not toxic to the retina, while further studies are necessary in order to clarify the safety of new-generation quinolones. 5-Fluorouracil has been shown to be nontoxic to the retina after an injection of 2.5 mg in animals. mAbs like ranibizumab and bevacizumab were demonstrated to be safe to the retina in cell culture, animals and humans at high doses. The exact biocompatibil- ity of nonsteroidal anti-inflammatory agents like diclofenac needs further evaluation. Preservatives like benzyl alcohol and changes in pH or osmolarity exert an influence on the toxic effects of intravitreally applied drugs. Conclusions: A great number of drugs are now used mainly intravitreally without relevant retinal toxicity. Copyright © 2010 S. Karger AG, Basel Key Words Avastin  Lucentis  Retina  Bevacizumab  Ranibizumab  Monoclonal antibodies  Tumor necrosis factor  Vascular endothelial growth factor  Corticosteroids  Antimetabolites  Triamcinolone  Nonsteroidal anti-inflammatory drugs  Microplasmin Abstract Aims: Retinal pharmacotherapy has gained great impor- tance for the treatment of various retinal diseases. An in- creasing number of drugs have been constantly released into the market, especially for wet age-related macular dis- ease and diabetic macular edema. In this review, the issues concerning the toxicity of current and new classes of drugs are discussed. Methods: An extensive search of the literature was performed to review various aspects of drug toxicity in retinal pharmacotherapy. The different major classes of drugs, such as corticosteroids, antibiotics, antimetabo- lites, antineoplastic agents, monoclonal antibodies (mAbs), nonsteroidal anti-inflammatory drugs, enzymes, fibrinolyt- ics, miscellaneous anti-inflammatory and antiangiogenic agents, as well as toxicity unrelated to the drug were identi- Received: August 17, 2009 Accepted after revision: October 5, 2009 Published online: August 10, 2010 Fernando Marcondes Penha, MD, PhD Emílio Fernandes Schoroeder, 111 Florianopolis, SC 88025-080 (Brazil) E-Mail penhaepm @ yahoo.com.br © 2010 S. Karger AG, Basel 0030–3747/10/0444–0205$26.00/0 Accessible online at: www.karger.com/ore