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Sub-Tenon's capsule triamcinolone acetonide injection to prevent brolucizumab-associated intraocular inflammation. Graefes Arch Clin Exp Ophthalmol 2022; 260:2529-2535. [PMID: 35235038 DOI: 10.1007/s00417-022-05611-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/14/2022] [Accepted: 02/22/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To investigate the efficacy of sub-Tenon's capsule triamcinolone acetonide (STTA) injections for preventing development of intraocular inflammation (IOI) related to intravitreal injection (IVI) of brolucizumab for neovascular age-related macular degeneration (nAMD). METHODS Consecutive patients with nAMD treated with brolucizumab IVIs were studied retrospectively. All eyes treated with brolucizumab in the clinic were switched from another anti-vascular endothelial growth factor agent. After the fourth case of IOI related to brolucizumab IVI, all eyes treated with brolucizumab received a STTA injection. The patients were divided into two groups: brolucizumab alone and brolucizumab combined with a STTA injection. RESULTS Forty-four eyes (44 patients) treated with at least one brolucizumab IVI were studied: 14 eyes received brolucizumab IVI alone and 30 eyes received the combination therapy. IOI related to brolucizumab IVIs developed in four (28.6%) of 14 eyes in the brolucizumab group; IOI was severe in one eye, moderate in two eyes, and mild in one eye according to the HAWK and HARRIER trial definition; IOI did not develop in the 30 eyes that received combination therapy, the difference of which reached significance (p = 0.012). Regarding combination therapy, the intraocular pressure in three (10%) eyes increased to 22 to about 26 mmHg after the STTA injection and returned to normal range within 2 months without medication; no cataracts developed during this short mean follow-up period follow-up period of 7.1 ± 0.4 months. CONCLUSION The results indicated the possible preventative effect of a STTA injection on development of brolucizumab-associated IOI.
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Jimenez-Vega A, Herencia-Anaya K, Palacios-Sánchez C, Cáceres-Del-Carpio J. Choroidopathy and optic neuropathy in systemic lupus erythematosus, a case report. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:34-39. [PMID: 35027143 DOI: 10.1016/j.oftale.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/19/2021] [Indexed: 06/14/2023]
Abstract
Although the associated ocular pathology to systemic lupus erythematosus is not infrequent, its manifestations and importance can be overlooked by rheumatologists and ophthalmologists. We present the case of a 44-year-old male with a history of systemic lupus erythematosus whose disease started with metamorphopsia and subjective alteration of the visual fields of both eyes, with a marked decrease in visual acuity, secondary to bilateral serous retinal detachment and optic neuropathy. He received systemic corticosteroids, biological therapy and posterior subtenon triamcinolone acetonide injections, showing an improvement in visual acuity. Ophthalmic manifestations should be considered a sign of systemic lupus erythematosus activity, therefore the treatment is essentially systemic, in combinationed with local coadjutant treatment.
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Affiliation(s)
- A Jimenez-Vega
- Servicio de Oftalmología, Hospital Nacional Edgardo Rebagliati Martins, Seguro Social de Salud - EsSalud, Lima, Peru
| | - K Herencia-Anaya
- Servicio de Oftalmología, Hospital Nacional Edgardo Rebagliati Martins, Seguro Social de Salud - EsSalud, Lima, Peru
| | - C Palacios-Sánchez
- Servicio de Oftalmología, Hospital Nacional Edgardo Rebagliati Martins, Seguro Social de Salud - EsSalud, Lima, Peru
| | - J Cáceres-Del-Carpio
- Servicio de Oftalmología, Hospital Nacional Edgardo Rebagliati Martins, Seguro Social de Salud - EsSalud, Lima, Peru; Facultad de Medicina Humana Manuel Huamán Guerrero, Universidad Ricardo Palma, Lima, Peru.
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3
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Zhao T, Lie H, Wang F, Liu Y, Meng X, Yin Z, Li S. Comparative Study of a Modified Sub-Tenon's Capsule Injection of Triamcinolone Acetonide and the Intravenous Infusion of Umbilical Cord Mesenchymal Stem Cells in Retinitis Pigmentosa Combined With Macular Edema. Front Pharmacol 2021; 12:694225. [PMID: 34646129 PMCID: PMC8503560 DOI: 10.3389/fphar.2021.694225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/15/2021] [Indexed: 11/22/2022] Open
Abstract
Retinitis pigmentosa (RP) is a hereditary retinal degenerative disease leading to eventual blindness. When RP is combined with macular edema (ME), the visual impairment further worsens. We compared a modified sub-Tenon’s capsule injection of triamcinolone acetonide (TA) and the intravenous infusion of umbilical cord mesenchymal stem cells (UCMSCs) in the treatment of RP combined with ME (RP-ME) to assess their safety and efficacy in eliminating ME and restoring visual function. A phase I/II clinical trial enrolled 20 patients was conducted. All patients were followed up for 6 months. There were no severe adverse effects in both groups. In retinal morphological tests, the central macular thickness (CMT) in TA group significantly decreased at first week, first and second month after injection (p < 0.05). The CMT in UCMSCs group significantly decreased at first month after infusion. The rate of reduction of CMT in TA group was significantly greater than that in UCMSCs group at second month (p < 0.05). Reversely, the rate of reduction of CMT in UCMSCs group was significantly greater than that in TA group at sixth month (p < 0.05). In visual functional test, although there were no significant differences in visual acuity or visual fields within each group or between groups, but the amplitude of P2 wave of flash visual evoked potential (FVEP) showed significant increasing in TA group at second month in UCMSCs group at sixth month (p < 0.05). At 6th month, the rate of growth in the amplitude of P2 wave in USMCSs group was significantly greater than that in TA group (p < 0.05). This study suggests both modified sub-Tenon’s capsule injection of TA and intravenous infusion of UCMSCs are safe for RP-ME patients. TA injection is more effective at alleviating ME while improving visual function in a short term. UCMSC intravenous infusion shows slow but persistent action in alleviating ME, and can improve the visual function for a longer time. These approaches can be applied separately or jointly depending on the disease condition for patients to benefit maximumly. Clinical Trial Registration:http://www.chictr.org.cn, identifier ChiCTR-ONC-16008839
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Affiliation(s)
- Tongtao Zhao
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Hongxuan Lie
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China.,Changhai Hospital, The Second Military Medical University (Naval Medical University), Shanghai, China
| | - Fang Wang
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Yong Liu
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Xiaohong Meng
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Zhengqin Yin
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Shiying Li
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
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Wu S, Bian C, Li X, Chen M, Yang J, Jin Y, Shen Y, Cheng L. Controlled release of triamcinolone from an episcleral micro film delivery system for open-globe eye injuries and proliferative vitreoretinopathy. J Control Release 2021; 333:76-90. [PMID: 33771623 DOI: 10.1016/j.jconrel.2021.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/05/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022]
Abstract
Open globe trauma is the major cause for single eye blindness that stem from subsequent proliferative vitreoretinopathy (PVR). Though biomaterials and tissue engineering have significantly advanced drug delivery and management of human diseases, currently there is no effective drug formulation or device to pharmacologically mitigate PVR formation after open-globe eye trauma. This highlighted the challenge we are facing to bring the technology from bench to bedside. The current study reported an engineered episcleral drug film using biodegradable material, Poly(L-lactide)-co-poly(ɛ-caprolactone), and triamcinolone acetonide (TA) as a model drug. The film can be conveniently sized into any shape to fit the configuration of the eye globe trauma and easily installed onto the ruptured sclera during primary trauma repair surgery. The film allows therapeutic TA to slow release for at least 6 months without toxicity and demonstrated a significant benefit to reduce the odds of developing severe PVR by 5.7 times when compared with a no-drug film control on a rabbit trauma PVR model. Our results suggested this micro episcleral drug film as promising drug delivery carrier for the targeted treatment of various unwanted retinal proliferation diseases.
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Affiliation(s)
- Shaoqun Wu
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, Zhejiang 325027, China
| | - Chengying Bian
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, Zhejiang 325027, China
| | - Xiaoli Li
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, Zhejiang 325027, China
| | - Miao Chen
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, Zhejiang 325027, China
| | - Jie Yang
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, Zhejiang 325027, China
| | - Yuanhui Jin
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, Zhejiang 325027, China
| | - Yu Shen
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, Zhejiang 325027, China
| | - Lingyun Cheng
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, Zhejiang 325027, China.
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Arie Y, Miyai H, Suzuki A, Okabe T, Takashima M, Takata M, Kurasawa T, Ito M, Arakawa R, Ogura Y, Naito A. Comparative study on pharmacokinetics and toxicity of intravitreal and sub-Tenon injection of triamcinolone acetonide in ocular tissues. Int J Ophthalmol 2020; 13:1864-1871. [PMID: 33344183 DOI: 10.18240/ijo.2020.12.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 08/26/2020] [Indexed: 12/21/2022] Open
Abstract
AIM To compare the differences in kinetics, distribution, and toxicity of triamcinolone acetonide (TA) between the injection methods, sub-Tenon and intravitreal injections in rabbit ocular tissues. METHODS TA was injected into the vitreous or the sub-Tenon in rabbits. For pharmacokinetic study, rabbits were sacrificed periodically and then TA in blood and ocular tissues (retina/choroids, vitreous, and aqueous humor) were measured over 91d. For toxicological study, clinical signs, slit-lamp microscopic examination, ophthalmological test were performed. The eyeballs and surrounding tissues were collected and fixed with glutaraldehyde-formalin solution, and then paraffin embedded for histological investigation. RESULTS Higher levels of TA were distributed in the intraocular tissues when injected into the vitreous compared to the sub-Tenon. Conversely, TA level was remarkably lower in the rabbits which received intravitreal TA injections than those treated with sub-Tenon injection throughout the study period in plasma. Optical discharge probably caused by systemic circulation of TA was observed by receiving sub-Tenon TA injection. Meanwhile, technic-associated toxicological ocular symptoms and findings were more frequently observed in intravitreal injection than in sub-Tenon injection. CONCLUSION There are significant differences in kinetics and distribution of TA in vitreous body, aqueous humor and plasma, between the two injection methods. Although further study is needed to explain the species difference between human and rabbit, it is assumed that the difference in the frequency of intraocular pressure elevation and cataract formation by TA between the two injection methods are directly related to the TA concentrations in aqueous humor and vitreous body in each injection methods. Systemic toxicity and technic-associated toxicity are also closely related to kinetics of TA in plasma and each injection method itself, respectively.
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Affiliation(s)
- Yuko Arie
- Sagami Research Laboratories, Wakamoto Pharmaceutical Corporation Ltd., Kanagawa 2580018, Japan
| | - Hiroko Miyai
- Sagami Research Laboratories, Wakamoto Pharmaceutical Corporation Ltd., Kanagawa 2580018, Japan
| | - Ayako Suzuki
- Sagami Research Laboratories, Wakamoto Pharmaceutical Corporation Ltd., Kanagawa 2580018, Japan
| | - Takeshi Okabe
- Sagami Research Laboratories, Wakamoto Pharmaceutical Corporation Ltd., Kanagawa 2580018, Japan
| | - Mitsuyo Takashima
- Sagami Research Laboratories, Wakamoto Pharmaceutical Corporation Ltd., Kanagawa 2580018, Japan
| | - Mayumi Takata
- Sagami Research Laboratories, Wakamoto Pharmaceutical Corporation Ltd., Kanagawa 2580018, Japan
| | - Takashi Kurasawa
- Sagami Research Laboratories, Wakamoto Pharmaceutical Corporation Ltd., Kanagawa 2580018, Japan
| | - Masaki Ito
- Sagami Research Laboratories, Wakamoto Pharmaceutical Corporation Ltd., Kanagawa 2580018, Japan
| | - Reijiro Arakawa
- Sagami Research Laboratories, Wakamoto Pharmaceutical Corporation Ltd., Kanagawa 2580018, Japan
| | - Yuichiro Ogura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya 4678601, Japan
| | - Akira Naito
- Sagami Research Laboratories, Wakamoto Pharmaceutical Corporation Ltd., Kanagawa 2580018, Japan
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Preoperative, Intraoperative and Postoperative Corticosteroid Use as an Adjunctive Treatment for Rhegmatogenous Retinal Detachment. J Clin Med 2020; 9:jcm9051556. [PMID: 32455658 PMCID: PMC7290919 DOI: 10.3390/jcm9051556] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 12/19/2022] Open
Abstract
The treatment for rhegmatogenous retinal detachment (RRD) is surgery, including pars plana vitrectomy (PPV) and scleral buckling (SB). Despite surgical advances, degeneration of the photoreceptors and post-operative complications, such as proliferative vitreoretinopathy (PVR), often occurs as the result of inflammation, preventing complete visual recovery or causing RRD recurrence. There is increasing evidence that in the presence of RRD, the activation of inflammatory processes occurs and the surgery itself induces an inflammatory response. This comprehensive review focuses on the use of different formulations of corticosteroids (CCS), as an adjunctive treatment to surgery, either PPV or SB, for RRD repair. The purpose was to review the efficacy and safety of CCS in improving functional and anatomical outcomes and in preventing postoperative complications. This review is organized according to the timing of CCS administration: preoperative, intraoperative, and postoperative. The evidence reviewed supported the role of the pre-operative use of CCS in the treatment of combined RRD and choroidal detachment (CD), reducing CD height. No solid consensus exists on intraoperative and postoperative use of CCS to treat and prevent postoperative complications. However, a large randomized clinical trial including more than 200 eyes suggested that oral prednisone after surgery decreases the rate of postoperative grade B PVR.
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7
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Sun Z, Liu X, Bian C, Wu S, Cheng L. Sub-Tenon depository triamcinolone and glycaemic management in diabetic patients. Acta Ophthalmol 2019; 97:e1027-e1028. [PMID: 30900817 DOI: 10.1111/aos.14100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Zuhua Sun
- Institute of Ocular Pharmacology, School of Ophthalmology and Optometry, Wenzhou Medical College, Wenzhou, China.,Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Xiaoling Liu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Chengying Bian
- Institute of Ocular Pharmacology, School of Ophthalmology and Optometry, Wenzhou Medical College, Wenzhou, China
| | - Shaoqun Wu
- Institute of Ocular Pharmacology, School of Ophthalmology and Optometry, Wenzhou Medical College, Wenzhou, China
| | - Lingyun Cheng
- Institute of Ocular Pharmacology, School of Ophthalmology and Optometry, Wenzhou Medical College, Wenzhou, China.,Jacob's Retina Center at Shiley Eye Center, Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
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8
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Ocular biopharmaceutics: impact of modeling and simulation on topical ophthalmic formulation development. Drug Discov Today 2019; 24:1587-1597. [PMID: 30959112 DOI: 10.1016/j.drudis.2019.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/07/2019] [Accepted: 04/02/2019] [Indexed: 12/12/2022]
Abstract
The estimation of ocular pharmacokinetics (PK) in various eye tissues is limited because of sampling challenges. Computational modeling and simulation (M&S) tools underpinning the elucidation of drug access routes and prediction of ocular exposure are essential for the mechanistic assessment of biopharmaceutics in the eye. Therefore, theoretical and experimental evaluation of ocular absorption and transit models is necessary. Biopharmaceutical parameter sensitivity analysis based on permeability and drug dose illustrates utility in ocular drug delivery assessment, which could have innovative and cost-saving impacts on ophthalmic product development and therapeutic bioequivalence (BE) evaluations.
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Santer V, Chen Y, Kalia YN. Controlled non-invasive iontophoretic delivery of triamcinolone acetonide amino acid ester prodrugs into the posterior segment of the eye. Eur J Pharm Biopharm 2018; 132:157-167. [PMID: 30266666 DOI: 10.1016/j.ejpb.2018.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/20/2018] [Accepted: 09/24/2018] [Indexed: 12/30/2022]
Abstract
This study investigated short duration transscleral iontophoretic delivery of four triamcinolone acetonide (TA) amino acid ester prodrugs (TA-AA) (alanine, Ala; arginine, Arg; isoleucine, Ile and lysine, Lys) using whole porcine eyes globes in vitro. Post-iontophoretic biodistribution of TA was quantified by UHPLC-MS/MS in the different ocular compartments (cornea, aqueous humor, sclera, ciliary body, choroid and retinal pigmented epithelium (RPE), neural retina and vitreous humor). Transscleral iontophoresis (3 mA/cm2 for 10 min) increased total drug delivery of the TA-AA prodrugs by 14-30-fold as compared to passive diffusion. The TA-AA prodrugs had distinct biodistribution profiles - the penetration depth achieved was dependent on their physicochemical properties (e.g. lipophilicity for TA-Ile) and susceptibility to hydrolysis (e.g. TA-Arg). Intraocular drug distribution was also influenced by prodrug binding to melanin (TA-Lys). Interestingly, under conditions of equivalent charge (6 mA/cm2 for 5 min vs. 1.5 mA/cm2 for 20 min, i.e. 1.44 C respectively) the longer duration (20 min) at lower current density resulted in ∼6 times more TA delivery into the vitreous humor. Overall, the study provided further evidence of the potential of transscleral iontophoresis for the non-invasive treatment of posterior segment inflammatory diseases.
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Affiliation(s)
- Verena Santer
- School of Pharmaceutical Sciences, University of Geneva & University of Lausanne, CMU-1, rue Michel Servet, 1211 Geneva 4, Switzerland
| | - Yong Chen
- School of Pharmaceutical Sciences, University of Geneva & University of Lausanne, CMU-1, rue Michel Servet, 1211 Geneva 4, Switzerland
| | - Yogeshvar N Kalia
- School of Pharmaceutical Sciences, University of Geneva & University of Lausanne, CMU-1, rue Michel Servet, 1211 Geneva 4, Switzerland.
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Cheng L. Where to inject the triamcinolone? J Cataract Refract Surg 2018; 44:416-417. [DOI: 10.1016/j.jcrs.2018.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Indexed: 11/16/2022]
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Clinical implication of triamcinolone in aqueous humor after depository sub-Tenon application. J Cataract Refract Surg 2017; 43:1383-1390. [DOI: 10.1016/j.jcrs.2017.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 11/19/2022]
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Awwad S, Mohamed Ahmed AHA, Sharma G, Heng JS, Khaw PT, Brocchini S, Lockwood A. Principles of pharmacology in the eye. Br J Pharmacol 2017; 174:4205-4223. [PMID: 28865239 DOI: 10.1111/bph.14024] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/14/2017] [Accepted: 08/17/2017] [Indexed: 12/18/2022] Open
Abstract
The eye is a highly specialized organ that is subject to a huge range of pathology. Both local and systemic disease may affect different anatomical regions of the eye. The least invasive routes for ocular drug administration are topical (e.g. eye drops) and systemic (e.g. tablets) formulations. Barriers that subserve as protection against pathogen entry also restrict drug permeation. Topically administered drugs often display limited bioavailability due to many physical and biochemical barriers including the pre-corneal tear film, the structure and biophysiological properties of the cornea, the limited volume that can be accommodated by the cul-de-sac, the lacrimal drainage system and reflex tearing. The tissue layers of the cornea and conjunctiva are further key factors that act to restrict drug delivery. Using carriers that enhance viscosity or bind to the ocular surface increases bioavailability. Matching the pH and polarity of drug molecules to the tissue layers allows greater penetration. Drug delivery to the posterior segment is a greater challenge and, currently, the standard route is via intravitreal injection, notwithstanding the risks of endophthalmitis and retinal detachment with frequent injections. Intraocular implants that allow sustained drug release are at different stages of development. Novel exciting therapeutic approaches include methods for promoting transscleral delivery, sustained release devices, nanotechnology and gene therapy.
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Affiliation(s)
- Sahar Awwad
- UCL School of Pharmacy, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Abeer H A Mohamed Ahmed
- UCL School of Pharmacy, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Garima Sharma
- UCL School of Pharmacy, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Jacob S Heng
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Peng T Khaw
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Steve Brocchini
- UCL School of Pharmacy, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Alastair Lockwood
- Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, UK
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Iranmanesh A, Gullapalli D, Singh R, Veldhuis JD. Hypothalamo-pituitary-adrenal axis after a single epidural triamcinolone injection. Endocrine 2017; 57:308-313. [PMID: 28674775 PMCID: PMC5554884 DOI: 10.1007/s12020-017-1357-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/14/2017] [Indexed: 01/03/2023]
Abstract
PURPOSE To quantify adrenocorticotropin and cortisol secretion after epidural glucocorticoid injection. METHODS Eight men (ages 25-63 year) were studied at baseline, 1, 4, and 12 weeks after triamcinolone (80 mg) injection epidurally. Adrenocorticotropin (pg/mL) and cortisol (µg/dL) were measured every 10 min for 4 h, and after Corticotropin-releasing hormone (CRH) (1 µg/kg) injection. RESULTS Epidural triamcinolone markedly suppressed: (1) pre-CRH injection ACTH (from 18 ± 3.1 to 4.8 ± 0.4: P < 0.01) and cortisol (from 12.2 ± 1.6 to 1.6 ± 0.3: P < 0.0001) at week 1, with recovery at 4 weeks, and (2) CRH-stimulated 3-h summed ACTH (from 633 ± 116 to 129 ± 10 pg/mL, P < 0.0001), and 3-h summed cortisol at week 1 (from 385 ± 29 to 56 ± 22 µg/dL, P < 0.0001) and 4 weeks (284 ± 53; P < 0.01). Serum cortisol was <18 µg/dL in eight of eight men at 4 weeks, and six of eight men at week 12. Urinary-free cortisol (µg/24 h) remained low at week 12: baseline (60 ± 6.5); week 1 (9.0 ± 1.3, P < 0.01); week 4 (36 ± 8.6) and week 12 (38 ± 4.1). Urinary cortisol/cortisone ratios rose at week 4 only. Serum triamcinolone peaked at week 1 (16/16 samples), declining at week 4 (13/16 samples) and week 12 (6/16 samples). LIMITATIONS Relatively small group. CONCLUSION Epidural triamcinolone suppresses unstimulated and CRH-stimulated ACTH and cortisol secretion for 1-4 weeks but urinary free cortisol ≥12 weeks. Suppression of ACTH and cortisol after glucocorticoid treatment is thus complex.
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Affiliation(s)
- Ali Iranmanesh
- Endocrine and Neurology Sections, Medical Service, Salem Veterans Affairs Medical Center, Salem, VA, 24153, USA
| | - Dakshinamurty Gullapalli
- Endocrine and Neurology Sections, Medical Service, Salem Veterans Affairs Medical Center, Salem, VA, 24153, USA
| | - Ravinder Singh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Johannes D Veldhuis
- Department of Medicine, Endocrine Research Unit, Mayo School of Graduate Medical Education, Clinical Translational Science Center, Mayo Clinic, Rochester, MN, 55905, USA.
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Pak KY, Choi BS, Park SW, Byon IS, Lee JE. Comparison of vitrectomized with nonvitrectomized eyes after subtenon injection of triamcinolone acetonide to treat diabetic macular edema: Retrospective comparative Analysis of an interventional case series. Indian J Ophthalmol 2017. [PMID: 28643714 PMCID: PMC5508460 DOI: 10.4103/ijo.ijo_627_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Triamcinolone acetonide (TA) is an alternative option for diabetic macular edema thanks to its cost-benefit ratio and unique delivery route. We performed this study to compare vitrectomized with nonvitrectomized eyes treated with subtenon TA injection for diabetic macular edema. MATERIALS AND METHODS We retrospectively reviewed the medical records of patients who had undergone subtenon TA injection for diabetic macular edema treatment. The patients were divided into two groups: Vitrectomized and nonvitrectomized. Visual acuity and central subfield macular thickness (CSMT) were analyzed before injection, at 1 and 3 months after injection. RESULTS Visual acuity in vitrectomized group improved significantly at 1 month (P = 0.002), but this improvement regressed after 3 months. In the nonvitrectomized group, visual acuity did not improve significantly after 1 month, but it did after 3 months (P = 0.019). The CSMT decreased significantly in both groups at 1 and 3 months (P < 0.001). There were no significant differences between the groups at either 1 or 3 months with regard to either visual improvement or change in CSMT. CONCLUSION Subtenon TA injection could be an alternative treatment option for diabetic macular edema, both in vitrectomized and in nonvitrectomized eyes. TA seems to take effect earlier and decay faster in vitrectomized eyes.
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Affiliation(s)
- Kang Yeun Pak
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University; Department of Ophthalmology, School of Medicine, Pusan National University, Busan, South Korea
| | - Beom Seok Choi
- Department of Ophthalmology, School of Medicine, Pusan National University; Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Sung Who Park
- Department of Ophthalmology, School of Medicine, Pusan National University; Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Ik Soo Byon
- Department of Ophthalmology, School of Medicine, Pusan National University, Busan; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Ji Eun Lee
- Department of Ophthalmology, School of Medicine, Pusan National University; Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
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Goyal S, Uwaydat SH. Multiquadrant Subtenon Triamcinolone Injection for Acute Corneal Graft Rejection: A Case Report. Case Rep Ophthalmol 2017. [PMID: 28626416 PMCID: PMC5471750 DOI: 10.1159/000477202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background We report a case of reversal of an acute corneal graft rejection following multiquadrant subtenon triamcinolone injection. Case Presentation A 19-year-old woman who had acute corneal graft rejection failed to show resolution of the graft rejection after standard treatment with systemic, intravenous, and topical steroids. The graft rejection, however, responded to injection of triamcinolone in multiple subtenon quadrants. Conclusions For corneal graft rejection, multiquadrant subtenon triamcinolone injections may be a safe adjunct to systemic treatment.
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Affiliation(s)
- Sunali Goyal
- Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sami H Uwaydat
- Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Kola M, Hacioglu D, Turk A, Erdol H. The effectiveness and reliability of posterior sub-Tenon triamcinolone acetonide injection in branch retinal vein occlusion-related macular edema. Cutan Ocul Toxicol 2015; 35:185-9. [PMID: 26340259 DOI: 10.3109/15569527.2015.1074586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate the effectiveness and reliability of posterior sub-Tenon triamcinolone acetonide (PSTA) application in branch retinal vein occlusion (BRVO)-related macular edema. METHODS Patients with confirmed BRVO-related macular edema were enrolled in the study. Patients were injected with a single, therapeutic dose of 40 mg PSTA. Detailed ophthalmic examination was performed at baseline and at 1, 3 and 6 months after the treatment. Best corrected visual acuity (BCVA), intraocular pressure (IOP), cataractogenic change (CC) and macular optical coherence tomography (OCT) analysis results were evaluated. The results were compared statistically. RESULTS Forty-one eyes of 41 patients with a mean age of 63.49 ± 10.99 (55-86) years, 15 (36.6%) females, were included in the study. BCVA in LogMAR values at 1 and 3 months were significantly better than at baseline, while no significant difference from baseline was observed in sixth month values (p < 0.001, p < 0.001 and p = 0.846, respectively). Central macular thickness values obtained using OCT were significantly lower at the first, third and sixth months compared to baseline (p < 0.001 for all). IOP elevation was determined in only two eyes (4.8%) at the end of the study period, and no CC was detected in any case. CONCLUSION PSTA application is an effective and safe option in BRVO-related macular edema.
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Affiliation(s)
- Mehmet Kola
- a Department of Ophthalmology, Faculty of Medicine , Karadeniz Technical University , Trabzon , Turkey
| | - Dilek Hacioglu
- a Department of Ophthalmology, Faculty of Medicine , Karadeniz Technical University , Trabzon , Turkey
| | - Adem Turk
- a Department of Ophthalmology, Faculty of Medicine , Karadeniz Technical University , Trabzon , Turkey
| | - Hidayet Erdol
- a Department of Ophthalmology, Faculty of Medicine , Karadeniz Technical University , Trabzon , Turkey
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Shen L, Mao J, Chen Y, Sun S, Han Y, Cheng L. Transscleral Permeation of Subtenon Triamcinolone in Different Vitreoretinal Diseases. Ophthalmology 2015; 122:649-51. [DOI: 10.1016/j.ophtha.2014.09.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 09/19/2014] [Accepted: 09/22/2014] [Indexed: 10/24/2022] Open
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Anayol MA, Toklu Y, Kamberoglu EA, Raza S, Arifoglu HB, Simavli H, Altintas AGK, Simsek S. Short-term effects of intravitreal triamcinolone acetonide injection on ocular blood flow evaluated with color Doppler ultrasonography. Int J Ophthalmol 2014; 7:811-5. [PMID: 25349798 DOI: 10.3980/j.issn.2222-3959.2014.05.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 12/26/2013] [Indexed: 12/23/2022] Open
Abstract
AIM To evaluate the changes in ocular blood flow with color Doppler ultrasonography (CDU) after intravitreal triamcinolone acetonide (IVTA) injection. METHODS A total of 46 patients who underwent IVTA (4 mg/0.1 mL) injection for diabetic macular edema (DME) (n=22), central retinal vein occlusion (CRVO) (n=12) and choroidal neovascular membrane (CNVM) (n=12) were included in the study. Peak systolic velocity (PSV), end diastolic velocity (EDV) and resistivity index (RI) were measured from the ophthalmic artery (OA), the central retinal artery (CRA) and the posterior ciliary artery (PCA) of each patient with CDU before, at the end of the first week and at the end of the first month following IVTA injection. RESULTS In the DME group, PSV of OA at the first of the first month (mean±SD) (37.48±10.87 cm/s) increased compared to pre-injection value (31.39±10.84 cm/s) (P=0.048). There was a statistically significant decrease (P=0.049) in PSV of CRA at the end of the first month (7.97±2.67 cm/s) compared to the pre-injection (9.47±3.37 cm/s). There was not any statistically significant difference on the other parameters in the DME group. Also, there was not any statistically significant difference on the ocular blood flow values in the CRVO and CNVM groups. CONCLUSION We observed that 4 mg/0.1 mL IVTA increased PSV of OA and decreased PSV of CRA in DME patients and did not have any effect on ocular blood flow values of CRVO and CNVM patients.
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Affiliation(s)
| | - Yasin Toklu
- Department of Ophthalmology, Ataturk Training and Research Hospital, Ankara 06800, Turkey
| | - Elif Asik Kamberoglu
- Department of Radiology, Kecioren Training and Research Hospital, Ankara 06280, Turkey
| | - Sabri Raza
- Department of Ophthalmology, Ataturk Training and Research Hospital, Ankara 06800, Turkey
| | - Hasan Basri Arifoglu
- Department of Ophthalmology, Kayseri Training and Research Hospital, Kayseri 38010, Turkey
| | - Huseyin Simavli
- Department of Ophthalmology, Bolu Izzet Baysal State Hospital, Bolu 14030, Turkey
| | | | - Saban Simsek
- Department of Ophthalmology, Yildirim Beyazit University School of Medicine, Ankara 06800, Turkey
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Intravitreal pharmacokinetics after posterior subtenon triamcinolone acetonide injection in vitrectomized rabbit eyes. Retina 2014; 34:801-6. [PMID: 24077088 DOI: 10.1097/iae.0000000000000000] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the intraocular pharmacokinetics of triamcinolone acetonide (TA) injected into the posterior subtenon of vitrectomized rabbit eyes. METHODS Vitrectomy was performed on the right eyes of 35 rabbits. Triamcinolone acetonide (40 mg/mL) was injected into the posterior subtenon space of both eyes. Five rabbits each were killed at days 1, 3, 7, 14, 28, 56, and 84. Both eyes were enucleated. The vitreous was isolated, and TA concentration was measured. RESULTS In vitrectomized eyes, the intravitreal concentrations of TA were 1763, 822.9, 321.5, 113.3, 35.5, 14.4, and 6.7 ng/mL, respectively, at the time points indicated above; the concentrations in nonvitrectomized eyes were 397.8, 360.4, 154.4, 48.5, 30.7, 15.2, and 8.0 ng/mL, respectively. Triamcinolone acetonide concentrations were significantly higher in the vitrectomized eyes at days 1, 3, 7, and 14. The terminal half-life of intravitreal TA was 23.3 days in the vitrectomized eyes and 28.9 days in the nonvitrectomized eyes. CONCLUSION Intravitreal absorption and excretion of TA in the posterior subtenon space are increased after vitrectomy. Although the terminal half-life of TA was shorter, higher early concentration and similar effective duration were achieved in the vitrectomized eyes.
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20
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Combining Cataract Surgery with 25-Gauge High-Speed Pars Plana Vitrectomy. Ophthalmology 2014; 121:299-304. [DOI: 10.1016/j.ophtha.2013.06.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/28/2013] [Accepted: 06/11/2013] [Indexed: 11/23/2022] Open
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Systemic treatments for noninfectious vitreous inflammation. Mediators Inflamm 2013; 2013:515312. [PMID: 24347829 PMCID: PMC3853923 DOI: 10.1155/2013/515312] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 09/26/2013] [Indexed: 12/14/2022] Open
Abstract
Vitreous inflammation, or vitritis, may result from many causes, including both infectious and noninfectious, including rheumatologic and autoimmune processes. Vitritis is commonly vision threatening and has serious sequelae. Treatment is frequently challenging, but, today, there are multiple methods of systemic treatment for vitritis. These categories include corticosteroids, antimetabolites, alkylating agents, T-cell inhibitors/calcineurin inhibitors, and biologic agents. These treatment categories were reviewed last year, but, even over the course of just a year, many therapies have made progress, as we have learned more about their indications and efficacy. We discuss here discoveries made over the past year on both existing and new drugs, as well as reviewing mechanisms of action, clinical dosages, specific conditions that are treated, adverse effects, and usual course of treatment for each class of therapy.
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Du W, Sun S, Xu Y, Li J, Zhao C, Lan B, Chen H, Cheng L. The effect of ocular pigmentation on transscleral delivery of triamcinolone acetonide. J Ocul Pharmacol Ther 2013; 29:633-8. [PMID: 23597073 PMCID: PMC3757532 DOI: 10.1089/jop.2012.0226] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 02/17/2013] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To determine the capacity and kinetics of the binding between triamcinolone acetonide (TA) and the ocular pigment for a better understanding of the transscleral delivery. METHODS In the in vitro study, natural melanin (sepia officinalis, Sigma-Aldrich) was incubated at 37°C with different concentrations of TA and the binding capacity/binding affinity was measured. The TA releasing profile from the melanin was also studied through repeated incubation of TA-melanin in fresh phosphate-buffed saline. In the ex vivo study, the effect of the choroidal pigment on the trans sclera/choroid permeability of TA was investigated through Franz-type vertical diffusion cells using both a TA suspension and a saturated TA solution. RESULTS The amount of TA bound to melanin increases with the increase of the TA concentration and with an increase in the incubation time. A Scatchard analysis revealed that the maximum number of moles of TA bound to melanin is predicted to be 22.43 nmol/mg, with a binding affinity of K=2.4×10(-5) nM(-1). TA released from a pigment showed a fast phase within the first 24 h and a slow phase thereafter. About 40% of the bound TA released in the first day and 73.94% of accumulative release was observed after 5 days. The TA suspension showed more TA penetration through the scleral-choroid complex than the saturated solution (P=0.0104). The apparent permeability coefficients for the suspension across the sclera-choroid of pigmented and albino rabbits are 7.48±1.53×10(-6) cm/s and 10.78±2.49×10(-6) cm/s, respectively. CONCLUSIONS TA can bind to and release from the ocular pigment, which may extend the TA ocular half-life and therapeutic duration when TA is delivered through a subtenon injection. A further in vivo study is warranted to validate the findings and to quantitate the magnitude of the difference between pigmented and albino animals.
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Affiliation(s)
- Wennan Du
- Wenzhou Medical College, Institute of Ocular Pharmacology, School of Ophthalmology and Optometry, Wenzhou, China
| | - Shumao Sun
- Wenzhou Medical College, Institute of Ocular Pharmacology, School of Ophthalmology and Optometry, Wenzhou, China
| | - Yu Xu
- Wenzhou Medical College, Institute of Ocular Pharmacology, School of Ophthalmology and Optometry, Wenzhou, China
| | - Jie Li
- Wenzhou Medical College, Institute of Ocular Pharmacology, School of Ophthalmology and Optometry, Wenzhou, China
| | - Chunhui Zhao
- Wenzhou Medical College, Institute of Ocular Pharmacology, School of Ophthalmology and Optometry, Wenzhou, China
| | - Bifei Lan
- Wenzhou Medical College, Institute of Ocular Pharmacology, School of Ophthalmology and Optometry, Wenzhou, China
| | - Hao Chen
- Wenzhou Medical College, Institute of Ocular Pharmacology, School of Ophthalmology and Optometry, Wenzhou, China
| | - Lingyun Cheng
- Wenzhou Medical College, Institute of Ocular Pharmacology, School of Ophthalmology and Optometry, Wenzhou, China
- Department of Ophthalmology, Jacob's Retina Center at Shiley Eye Center, University of California San Diego, La Jolla, California
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Chhablani J, Nieto A, Hou H, Wu EC, Freeman WR, Sailor MJ, Cheng L. Oxidized porous silicon particles covalently grafted with daunorubicin as a sustained intraocular drug delivery system. Invest Ophthalmol Vis Sci 2013; 54:1268-79. [PMID: 23322571 DOI: 10.1167/iovs.12-11172] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To test the feasibility of covalent loading of daunorubicin into oxidized porous silicon (OPS) and to evaluate the ocular properties of sustained delivery of daunorubicin in this system. METHODS Porous silicon was heat oxidized and chemically functionalized so that the functional linker on the surface was covalently bonded with daunorubicin. The drug loading rate was determined by thermogravimetric analysis. Release of daunorubicin was confirmed in PBS and excised rabbit vitreous by mass spectrometry. Daunorubicin-loaded OPS particles (3 mg) were intravitreally injected into six rabbits, and ocular properties were evaluated through ophthalmic examinations and histology during a 3-month study. The same OPS was loaded with daunorubicin using physical adsorption and was evaluated similarly as a control for the covalent loading. RESULTS In the case of covalent loading, 67 ± 10 μg daunorubicin was loaded into each milligram of the particles while 27 ± 10 μg/mg particles were loaded by physical adsorption. Rapid release of daunorubicin was observed in both PBS and excised vitreous (~75% and ~18%) from the physical adsorption loading, while less than 1% was released from the covalently loaded particles. Following intravitreal injection, the covalently loaded particles demonstrated a sustained degradation of OPS with drug release for 3 months without evidence of toxicity; physical adsorption loading revealed a complete release within 2 weeks and localized retinal toxicity due to high daunorubicin concentration. CONCLUSIONS OPS with covalently loaded daunorubicin demonstrated sustained intravitreal drug release without ocular toxicity, which may be useful to inhibit unwanted intraocular proliferation.
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Affiliation(s)
- Jay Chhablani
- Department of Ophthalmology, Jacobs Retina Center at the University of California-San Diego, La Jolla, CA 92093, USA
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Systemic treatment of vitreous inflammation. Mediators Inflamm 2012; 2012:936721. [PMID: 23028205 PMCID: PMC3457724 DOI: 10.1155/2012/936721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 08/21/2012] [Indexed: 02/07/2023] Open
Abstract
Non infectious vitreous inflammation is often vision threatening and can be associated with potentially life-threatening systemic conditions. Treatment is often challenging as it involves systemic medications that can be associated with adverse effects. The classes of drugs are ever expanding and include corticosteroids, antimetabolites, alkylating agents, T-cell and calcineurin agents, biologic agents, and interferons. Each class of systemic therapy for non-infectious vitreous inflammation is reviewed. We discuss the mechanisms of action, usual clinical dosages, the specific conditions that are treated, the adverse effects, and usual course of treatment for each class of therapy.
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