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Important reminders for the injection of XIPERE®

XIPERE® is the first and only corticosteroid indicated to treat uveitic macular edema by utilizing the novel pathway of the suprachoroidal space (SCS®) to deliver treatment to the posterior tissues of the eye.1,2

The innovative injection procedure of XIPERE® with the SCS Microinjector® requires a different approach than traditional intravitreal injection.2

The PDS Approach

  • Perpendicular
  • Dimple
  • Slow

Three important steps to remember during injection2

microinjector perpendicular microinjector perpendicular
1

Hold the microinjector perpendicular to the ocular surface

creating a dimple creating a dimple
2

Compress the sclera, creating a dimple on the ocular surface

Maintain the dimple on the ocular surface

Slowly inject Slowly inject
3

Slowly inject over 5 - 10 seconds

IMPORTANT:

It is recommended to use 2 hands to hold the microinjector while injecting to effectively “dimple” the conjunctiva with the needle hub to enable treatment to reach the SCS®.1-3

As the first and only treatment approved to be delivered via the SCS®, the administration and preparation of XIPERE® is unique and distinct from that of a conventional intravitreal injection.2

Unlike typical intravitreal injections, XIPERE® relies on the expansion of the SCS® during injection to allow targeted therapy to reach the posterior structures of the eye. Best treatment outcomes are achieved in patients when proper injection protocol is followed, allowing XIPERE® to effectively reach the posterior tissues of the eye where uveitic macular edema is taking place.1

Best Practices for Injection

These aspects of administration are crucial to a successful injection of XIPERE.2

Preparation for administration

  1. Clean the outside of the vial with an alcoholic wipe, as the outside top is not sterile
  2. Shake the triamcinolone vial vigorously for 10 seconds before attaching to the syringe
  3. When attaching the syringe, place the triamcinolone vial on a flat surface
  4. Be sure to avoid overtightening the needle when attaching the loading vial to avoid potential difficulty with disassembly later
  5. Do not load the syringe any sooner than 15 minutes prior to the injection to avoid the risk of clogging the syringe due to settling of the suspension
  6. Pull down on the plunger completely to load the syringe. Then, after attaching the needle, express up to the 0.1-mL line to remove any air in the needle

Administration

  1. When injecting, only handle the syringe by the barrel
  2. For delivery, the 2-handed injection technique is preferred to properly perform the injection over the allotted 5- to 10-second timeframe
  3. Maintain consistent light pressure on the plunger and increase the pressure on the syringe until reaching the suprachoroidal space
  4. Maintain pressure on the syringe for 5 seconds after the injection is complete to prevent any potential reflux
    • - If reflux of triamcinolone around the injection site is seen, you have not yet reached the suprachoroidal space and need to further dimple the sclera
  5. After completing the injection, slowly remove the needle and place a sterile cotton swab over the injection site

Switching to 1100-micron microinjection needle

  1. If resistance continues and patient safety is not at risk, you may use medical judgment to change to the 1100-micron needle
  2. Be sure to express the syringe prior to removing the 900-micron needle
    • - Once you have removed the needle, follow the same attachment instructions used for the 900-micron needle to attach the new 1100-micron needle, and then refill the syringe
  3. Vigorously shake the vial again if switching to the 1100-micron needle, as time has elapsed

Correct injection technique is a critical factor in attaining successful patient experience and treatment outcomes. As a reminder, you can schedule further training by reaching out to your local representative.

Indication

XIPERE® (triamcinolone acetonide injectable suspension) for suprachoroidal use is a corticosteroid indicated for the treatment of macular edema associated with uveitis.

Important Safety Information

Patients should be monitored following injection for elevated intraocular pressure. See Dosage and Administration instructions in full Prescribing Information.

  • XIPERE® is contraindicated in patients with active or suspected ocular or periocular infections including most viral diseases of the cornea and conjunctiva, including active epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella, mycobacterial infections, and fungal diseases.
  • XIPERE® is contraindicated in patients with known hypersensitivity to triamcinolone acetonide or any other components of this product.
  • Use of corticosteroids may produce cataracts, increased intraocular pressure, and glaucoma. Use of corticosteroids may enhance the establishment of secondary ocular infections due to bacteria, fungi, or viruses, and should be used cautiously in patients with a history of ocular herpes simplex.
  • Hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing’s syndrome, and hyperglycemia can occur following administration of a corticosteroid. Monitor patients for these conditions with chronic use.
  • In controlled studies, the most common ocular adverse reactions were increased ocular pressure, non-acute (14%), eye pain, non-acute (12%), cataract (7%), increased intraocular pressure, acute (6%), vitreous detachment (5%), injection site pain (4%), conjunctival hemorrhage (4%), visual acuity reduced (4%), dry eye (3%), eye pain, acute (3%), photophobia (3%), and vitreous floaters (3%), and in 2% of patients: uveitis, conjunctival hyperaemia, punctate keratitis, conjunctival oedema, meibomianitis, anterior capsule contraction, chalazion, eye irritation, eye pruritus, eyelid ptosis, photopsia, and vision blurred.
    The most common non-ocular adverse event was headache (5%).
  • Corticosteroids should be used during pregnancy or nursing only if the potential benefit justifies the potential risk to the fetus or nursing infant.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please click here for full Prescribing Information.

References

1.Chiang B, Jung JH, Prausnitz MR. The suprachoroidal space as a route of administration to the posterior segment of the eye. Adv Drug Deliv Rev. 2018;126:58-66.

2.XIPERE® [prescribing information]. Alpharetta, GA: Clearside Biomedical, Inc.

3.Moisseiev E, Loewenstein A, Yiu G. The suprachoroidal space: from potential space to space with potential. Clin Ophthalmol. 2016;10:173-178.

See More

Indication

XIPERE® (triamcinolone acetonide injectable suspension) for suprachoroidal use is a corticosteroid indicated for the treatment of macular edema associated with uveitis.

Important Safety Information

Patients should be monitored following injection for elevated intraocular pressure. See Dosage and Administration instructions in full Prescribing Information.

  • XIPERE® is contraindicated in patients with active or suspected ocular or periocular infections including most viral diseases of the cornea and conjunctiva, including active epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella, mycobacterial infections, and fungal diseases.
  • XIPERE® is contraindicated in patients with known hypersensitivity to triamcinolone acetonide or any other components of this product.