Gemase is an enzyme thrombolytic (fibrinolytic) agent intended for use in ophthalmic practice.
Release form and composition
The drug is available in the form of lyophlisate for the preparation of injection solution. One ampoule of Hemase contains 5,000 IU of recombinant prourokinase as an active substance (equivalent to 0.0588 mg), as well as auxiliary components: dextran 40 and sodium chloride.
Indications for use
According to the instructions to Gemaze, the drug is used for:
- Hemophthalmus (hemorrhage into the eye cavity or, in other words, into the vitreous body of the eye);
- Hyphema (hemorrhage in the anterior chamber of the eye);
- Preretinal (into the space between the nerve fiber layer and the posterior hyaloid membrane of the vitreous), subretinal (into the space between the layers of the neuroepithelium of the retina and pigment epithelium) or intraretinal (into the retina) hemorrhage;
- Fibrioid syndrome of different nature of origin;
- Occlusion (acute circulatory disorders) of the central retinal artery, as well as its branches;
- Thrombosis of the central retinal vein (the formation of a blood clot inside it), as well as thrombosis of its branches.
As a prophylactic agent, Gemaza can be prescribed to prevent the development of adhesions in the postoperative period after the removal of glaucoma.
Application Gemazy, according to the instructions, is contraindicated in:
- Hypersensitivity to the drug;
- Conditions that are characterized by an increased risk of bleeding (including hemorrhagic diathesis);
- Bleeding from the digestive tract;
- Infectious (bacterial) endocarditis;
- Active tuberculosis (open);
- Proliferative retinopathy (accompanied by gliosis of diabetic retinopathy III-IV degree);
- Hypertension, in which the rate of diastolic pressure above 105 mm Hg. v .;
- Chronic renal failure;
- Hypertensive crisis (this is due to the likelihood of recurrence of hemorrhage in the eye);
- Severe hepatocellular insufficiency, in which the concentration of albumin in the blood does not exceed 3 g;
Since there is insufficient data on the safety and efficacy of the use of Hemase in pediatrics, the drug should not be administered to children and adolescents under 18 years of age.
Dosing and Administration
To prepare the solution Gemaza for parabulbar (through the skin in the lower eyelid) or subconjunctival (under the conjunctiva of the eye) administration, the contents of one ampoule must be diluted with 0.5 ml of saline. A full course of treatment with Hemase involves the introduction of 10 single doses of the drug.
In cases of hemorrhage into the anterior chamber of the eye (hyphema), as well as in cases characterized by intense efflux of fibrin, a freshly prepared solution of Gemaza should be used to wash the anterior chamber of the eye. To prepare the drug, the lyophilized mass from one ampoule is diluted in 1 ml of sodium chloride solution, after which 0.2 to 0.1 ml of the resulting solution is taken and diluted once again to 0.5 ml with sterile saline.
To prepare the solution for intravitreal administration, the lyophilized mass contained in one ampoule is diluted in 1 ml of sodium chloride solution, after which 0.1 ml is taken and 0.1-0.2 ml of sterile saline is diluted once more, to a volume of 0, 2 or 0.3 ml. The resulting volume of the drug is intended for a single intravitreal injection.
The presence of effusion of fibrin or hyphema after cataract surgery involves parabulbar or subconjunctival administration of Gemazy, as well as injections into the anterior chamber of the eye.
For hemorrhages into the retina or vitreous of the eye, as well as for occlusive lesions of the optic nerve or retinal vessels, the patient is shown parabulbar injection of the solution.
In hemophthalmus and fibrinoid syndrome, Gemazy should be administered intravitreal.
To prevent the development of adhesions after undergoing antiglaucomatous surgery, the lyophilisate is diluted in the ratio indicated for subconjunctival injections. And in this case, the drug is introduced into the filtration pad in the early postoperative period. At the discretion of the surgeon can be assigned from 1 to 3 injections.
The use of Hemase may be accompanied by side effects, which are most often expressed in the form of allergic reactions, manifested by:
- Edema and hyperemia of the face (on the side of drug administration);
- Inflammation of the shadow capsule of the eye (manifested by a decrease in the mobility of the eyeball, hyperemia and chemosis of the conjunctiva).
With the development of arterial hypotension and bradycardia in a patient, treatment with Gemaza should be suspended until the blood pressure stabilizes and the heart rate index normalizes.
To reduce the likelihood of development of hemorrhage during surgical operations simultaneously with Gemaza it is recommended to use etamzilat - 250-500 mg intramuscularly.
The tool should be used with caution in combination with other thrombolytics.
During the period of treatment with this drug, care should be taken when driving and working with complex mechanisms.
A structural analogue of Hemazy is Purolase preparation.
The group of drugs with a similar mechanism of action includes Aktilize, Zigris, Metalize, Sepratin, Streptodekaza, Streptokinase, Trombovazim, Tromboflux, Urokinase Medak, Fibrinolizin, Celiasa, Eberkinase, Fortelizin, Trombovazim.
Terms and conditions of storage
Gemaza is a prescription drug. According to the manufacturer's recommendations, ampoules should be stored in a dark place at a temperature of 2 to 20 ºС. The shelf life of the lyophilisate is 4 years.