Photrexa Cross-linking Kit

Clinical summary

Indications and usage 1 INDICATIONS AND USAGE PHOTREXA ® VISCOUS and PHOTREXA ® are indicated for use in corneal collagen cross-linking in combination with the KXL ® System for the treatment of PHOTREXA VISCOUS and PHOTREXA are photoenhancers indicated for use with the KXL System in corneal collagen cross-linking for the treatment of progressive keratoconus ( 1.1 ) and corneal ectasia following refractive surgery ( 1.2 ). 1.1 Progressive Keratoconus 1.2 Corneal Ectasia Following Refractive Surgery Dosage and administration 2 DOSAGE AND ADMINISTRATION Using topical anesthesia, debride the epithelium to a diameter of approximately 9 mm using standard aseptic technique. Post epithelial debridement, instill 1 drop of PHOTREXA VISCOUS topically on the eye every 2 minutes for 30 minutes. At the end of the 30 minute soaking period, examine the eye under the slit lamp for the presence of a yellow flare in the anterior chamber. If the yellow flare is not detected, instill 1 drop of PHOTREXA VISCOUS every 2 minutes for an additional 2 to 3 drops and recheck for the presence of a yellow flare. This process can be repeated as necessary. Once the yellow flare is observed, perform ultrasound pachymetry. If corneal thickness is less than 400 microns, instill 2 drops of PHOTREXA every 5 to 10 seconds until the corneal thickness increases to at least 400 microns. Irradiation should not be performed unless this 400 micron threshold is met and the yellow flare is seen. Irradiate the eye for 30 continuous minutes at 3mW/cm 2 at a wavelength of 365 nm, centered over the cornea, using the KXL System as per the instructions in the KXL manual. During irradiation, continue topical instillation of PHOTREXA VISCOUS onto the eye every 2 minutes for the 30 minute irradiation period. For topical ophthalmic use. Do not inject. Single use PHOTREXA VISCOUS and PHOTREXA only. Discard syringe(s) after use. PHOTREXA VISCOUS and PHOTREXA are for use with the KXL System only. PLEASE REFER TO THE KXL OPERATOR’S MANUAL FOR SPECIFIC DEVICE INSTRUCTIONS. Debride the epithelium using standard aseptic technique using topical anesthesia ( 2 ). Then instill 1 drop of PHOTREXA VISCOUS topically on the eye every 2 minutes for 30 minutes ( 2 ). After 30 minutes, examine the eye under slit lamp for presence of a yellow flare in the anterior chamber. If flare is not detected, instill 1 drop of PHOTREXA VISCOUS every 2 minutes for an additional 2 to 3 drops and recheck for yellow flare. Repeat as necessary ( 2 ). Once flare is observed, perform ultrasound pachymetry. If corneal thickness is less than 400 microns, instill 2 drops of PHOTREXA every 5 to 10 seconds until the corneal thickness increases to at least 400 microns ( 2 ). Irradiation should not be performed unless this 400 micron threshold is met and the yellow flare is seen ( 2 ). Irradiate the eye for 30 minutes at 3mW/cm 2 using the KXL System as per the instructions in the KXL manual. During irradiation, continue topical instillation of PHOTREXA VISCOUS onto the eye every 2 minutes for the 30 minute irradiation period ( 2 ). Refer to the KXL Operator’s manual for specific device instructions ( 2 ). Warnings and cautions 5 WARNINGS AND PRECAUTIONS Ulcerative keratitis can occur. Monitor for resolution of epithelial defects. [See Adverse Reactions (6) ] . Ulcerative keratitis can occur. Monitor for resolution of epithelial defects ( 5 ) Pregnancy 8.1 Pregnancy Risk Summary Animal development and reproduction studies have not been conducted with the PHOTREXA ® VISCOUS/PHOTREXA ® /KXL ® System. Since it is not known whether the corneal collagen cross-linking procedure can cause fetal harm or affect reproduction capacity, it should not be performed on pregnant women.