Investigation of the motion of a viscous fluid in the vitreous cavity induced by eye rotations and implications for drug delivery

The Role of Eye Movements in the Process of Silicone Oil Emulsification After Vitreoretinal Surgery

Emulsification is a feared and common complication of the use of silicone oil (SO) as tamponade fluid after vitrectomy as it potentially associated with significant risks to ocular health, including elevated intraocular pressure (IOP), glaucoma, corneal and retinal changes. The aim of this study was to investigate the role and interplay of physical factors on the formation of SO emulsion. Experiments were performed in a model of the vitreous chamber with a realistic shape, filled with SO and an aqueous solution containing different concentrations of albumin, an endogenous protein known to modify the interfacial properties between SO and aqueous solutions. The model was subjected to harmonic and saccadic rotations and kept at body temperature. Results indicated that no emulsions were detected in the absence of albumin in the aqueous solution, while the presence of the protein facilitated emulsion formation, acting as a surfactant. Mechanical energy from eye movements was also found to be a key mechanism to produce emulsification, with higher mechanical energy provided to the system leading to smaller droplet sizes. The emulsions formed were stable over extended times. This study highlights the complex interplay of factors influencing SO emulsification in the vitreous chamber. A better understanding of the mechanisms underlying SO emulsification is crucial for developing strategies to mitigate SO emulsion and the related complications.

Drug Distribution After Intravitreal Injection: A Mathematical Model

Purpose

Intravitreal injection of drugs is commonly used for treatment of chorioretinal ocular pathologies, such as age-related macular degeneration. Injection causes a transient increase in the intraocular volume and, consequently, of the intraocular pressure (IOP). The aim of this work is to investigate how intravitreal flow patterns generated during the post-injection eye deflation influence the transport and distribution of the injected drug.

Methods

We present mathematical and computational models of fluid motion and mass transport in the vitreous chamber during the transient phase after injection, including the previously unexplored effects of globe deflation as ocular volume decreases.

Results

During eye globe deflation, significant fluid velocities are generated within the vitreous chamber, which can possibly contribute to drug transport. Pressure variations within the eye globe are small compared to IOP.

Conclusions

Even if significant fluid velocities are generated in the vitreous chamber after drug injection, these are found to have negligible overall effect on drug distribution.

The Roles of Vitreous Biomechanics in Ocular Disease, Biomolecule Transport, and Pharmacokinetics

PURPOSE

The biomechanical properties of the vitreous humor and replication of these properties to develop substitutes for the vitreous humor have rapidly become topics of interest over the last two decades. In particular, the behavior of the vitreous humor as a viscoelastic tissue has been investigated to identify its role in a variety of processes related to biotransport, aging, and age-related pathologies of the vitreoretinal interface.

METHODS

A thorough search and review of peer-reviewed publications discussing the biomechanical properties of the vitreous humor in both human and animal specimens was conducted. Findings on the effects of biomechanics on vitreoretinal pathologies and vitreous biotransport were analyzed and discussed.

RESULTS

The pig and rabbit vitreous have been found to be most mechanically similar to the human vitreous. Age-related liquefaction of the vitreous creates two mechanically unique phases, with an overall effect of softening the vitreous. However, the techniques used to acquire this mechanical data are limited by the in vitro testing methods used, and the vitreous humor has been hypothesized to behave differently in vivo due in part to its swelling properties. The impact of liquefaction and subsequent detachment of the vitreous humor from the posterior retinal surface is implicated in a variety of tractional pathologies of the retina and macula. Liquefaction also causes significant changes in the biotransport properties of the eye, allowing for significantly faster movement of molecules compared to the healthy vitreous. Recent developments in computational and ex vivo models of the vitreous humor have helped with understanding its behavior and developing materials capable of replacing it.

CONCLUSIONS

A better understanding of the biomechanical properties of the vitreous humor and how these relate to its structure will potentially aid in improving clinical metrics for vitreous liquefaction, design of biomimetic vitreous substitutes, and predicting pharmacokinetics for intravitreal drug delivery.

Optimal Design of a Multipole-Electromagnet Robotic Platform for Ophthalmic Surgery

The aim of this study was to design a multipole-electromagnet robotic platform named OctoRob. This platform provides a minimally invasive means for targeted therapeutic interventions in specific intraocular areas. OctoRob is capable of generating both appropriate magnetic fields and gradients. The main scientific objectives were: (i) To propose an optimal reconfigurable arrangement of electromagnets suitable for ophthalmic interventions. (ii) To model, design and implement a one-degree-of-freedom robotic arm connected with an electromagnet in order to optimize the generation of magnetic fields and gradients. (iii) To evaluate the magnetic performances of the OctoRob platform, including different tilted angles. The results show that OctoRob platform has great potential to be applied for ophthalmic surgery.

Stability of the Interface Between Two Immiscible Liquids in a Model Eye Subject to Saccadic Motion

The interface between silicone oil and saline layers in a three-dimensional model of the eye chamber was studied under different eye-like saccadic motions in order to determine the stability of the interface and propensity for emulsification in the bulk. The effect of level of fill, saccade amplitude, angular velocity, latency time, and orientation were investigated experimentally in spherical flasks with internal diameters 10, 28, and 40 mm, as well as a 28 mm diameter flask with an indent replicating the lens or the presence of a buckle. The deformation of the interface was quantified in terms of the change in its length in two-dimensional images. The deformation increased with Weber number, We, and was roughly proportional to We for We > 1. The presence of the lens gave rise to higher deformation near this feature. In all cases emulsification was not observed in either bulk fluid. The velocity profile in the spherical configuration was mapped using particle imaging velocimetry and is compared with an analytical solution and a short computational fluid dynamics simulation study. These confirm that the saccadic motion induces flow near the wall in the saline layer and significantly further into the chamber in the silicone oil. Surfactants soluble in the aqueous and oil phases reduced the interfacial tension, increasing deformation but did not lead to emulsification in the bulk.

Macro- and Microscale Properties of the Vitreous Humor to Inform Substitute Design and Intravitreal Biotransport

Research on the vitreous humor and development of hydrogel vitreous substitutes have gained a rapid increase in interest within the past two decades. However, the properties of the vitreous humor and vitreous substitutes have yet to be consolidated. In this paper, the mechanical properties of the vitreous humor and hydrogel vitreous substitutes were systematically reviewed. The number of publications on the vitreous humor and vitreous substitutes over the years, as well as their respective testing conditions and testing techniques were analyzed. The mechanical properties of the human vitreous were found to be most similar to the vitreous of pigs and rabbits. The storage and loss moduli of the hydrogel vitreous substitutes developed were found to be orders of magnitude higher in comparison to the native human vitreous. However, the reported modulus for human vitreous, which was most commonly tested in vitro, has been hypothesized to be different in vivo. Future studies should focus on testing the mechanical properties of the vitreous in situ or in vivo. In addition to its mechanical properties, the vitreous humor has other biotransport mechanisms and biochemical functions that establish a redox balance and maintain an oxygen gradient inside the vitreous chamber to protect intraocular tissues from oxidative damage. Biomimetic hydrogel vitreous substitutes have the potential to provide ophthalmologists with additional avenues for treating and controlling vitreoretinal diseases while preventing complications after vitrectomy. Due to the proximity and interconnectedness of the vitreous humor to other ocular tissues, particularly the lens and the retina, more interest has been placed on understanding the properties of the vitreous humor in recent years. A better understanding of the properties of the vitreous humor will aid in improving the design of biomimetic vitreous substitutes and enhancing intravitreal biotransport.

Thermal Effects on Fluid Mixing in the Eye

Age-related macular degeneration (AMD) is the leading cause of central vision loss in the developed world. Wet AMD can be managed through serial intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents. However, sometimes the treatment is ineffective. Given that the half-life of the drug is limited, inefficient mixing of the injected drug in the vitreous chamber of the eye may contribute to the ineffectiveness. Here, we introduce thermal heating as a means of enhancing the mixing-process in the vitreous chamber and investigate parameters that potentially influence its effectiveness. Our in vitro studies reveal the importance of the heating location on the eye. A significant increase in the mixing and delivery of drugs to the targeted area (the macula) could be achieved by placing heating pads to induce a current, against gravity, in the vitreous. The presented results can potentially help in the development of a better strategy for intravitreal injection, subsequently improving the quality of patient care.

Precision Intravitreal Chemotherapy for Localized Vitreous Seeding of Retinoblastoma

Purpose

To describe and evaluate the effectivity of a novel precision intravitreal injection technique for select cases of localized vitreous seeding in retinoblastoma.

Methods

Patients with localized vitreous seeds from retinoblastoma received intravitreal chemotherapy via a precision injection technique (P-IVitC) intended to optimize local delivery of melphalan to target seeds. The needle was inserted trans-pars plana and chemotherapy deposited within 3 mm of the target seed(s) under indirect ophthalmoscopic guidance. Without subsequent globe manipulation, the head was then positioned to promote gravity-dependent settling of chemotherapy.

Results

There were 8 eyes of 8 patients treated with P-IVitC for active vitreous seeds following adequate solid tumor control with intravenous chemotherapy (n = 3, 38%) or intra-arterial chemotherapy (n = 5, 63%). Viable vitreous seeds were primarily solitary spheres (n = 6, 75%) and measured an average of 2.7 mm in diameter. Vitreous seed resolution (n = 8, 100%) was noted after a mean of 2.6 injections (median 2; range 1-3) of 20 μg melphalan. There was no recurrence at a mean follow-up of 10.0 months. Only 1 eye had an associated complication (focal retinal pigment epithelial mottling, n = 1, 13%).

Conclusions

With direct delivery of chemotherapy to within 3-4 mm of vitreous seed activity, P-IVitC provided complete control of localized vitreous seeds with minimal toxicity.

In vitro and ex vivo models to study drug delivery barriers in the posterior segment of the eye

Many ocular disorders leading to blindness could benefit from efficient delivery of therapeutics to the retina. However, despite extensive research into drug delivery vehicles and administration techniques, efficacy remains limited because of the many static and dynamic barriers present in the eye. Comprehension of the various barriers and especially how to overcome them can improve our ability to estimate the potential of existent drug delivery vectors and support the design of new ones. To this end, this review gives an overview of the most important ocular barriers for each administration route to the back of the eye. For each barrier, its biological composition and its role as an obstacle towards macromolecules, nanoparticles and viral vectors will be discussed; special attention will be paid to the influence of size, charge and lipophilicity of drug(s) (carrier) on their ability to overcome each barrier. Finally, the most significant available in vitro and ex vivo methods and models to test the potential of a therapeutic to cross each barrier are listed.

Minimally invasive curved-micro-drainer (CMD) capable of innocuous drainage of subretinal fluid for the treatment of retinal detachment

Retinal detachment is a serious vision threatening disease. Current consensus for the treatment of retinal detachment is to reattach the retina onto the choroid layer by drainage of accumulated subretinal fluid. Although several surgical methods have been developed, no satisfactory visual outcome has been obtained without surgical complications such as unintended puncture and hemorrhage of the retina and choroid tissue. In this study, we developed a novel Curved-Micro-Drainer (CMD) for the innocuous drainage of subretinal fluid. It is a curved structure with a 15° beveled tip that is 5 mm in length, with an 80 μm inner diameter and a 100 μm outer diameter. This high inner-to-outer diameter ratio of CMD with a 100 μm outer diameter allows efficient drainage of highly viscous subretinal fluid in a minimally invasive manner. In addition, the curved structure precisely matches the spherical ocular structure, which facilitates the CMD insertion into the subretinal space without choroid tissue damage. We demonstrate that the optimized CMD allows for the innocuous drainage of the viscous subretinal fluid from the porcine eye, whereas the traditional hypodermic needle (31-gauge) induces severe retinal and choroid damage. CMD can overcome a critical safety issue and is a potential alternative to conventional surgical interventions for the innocuous drainage of subretinal fluid.

Computational modeling of intraocular gas dynamics

The purpose of this study was to develop a computational model to simulate the dynamics of intraocular gas behavior in pneumatic retinopexy (PR) procedure. The presented model predicted intraocular gas volume at any time and determined the tolerance angle within which a patient can maneuver and still gas completely covers the tear(s). Computational fluid dynamics calculations were conducted to describe PR procedure. The geometrical model was constructed based on the rabbit and human eye dimensions. SF6 in the form of pure and diluted with air was considered as the injected gas. The presented results indicated that the composition of the injected gas affected the gas absorption rate and gas volume. After injection of pure SF6, the bubble expanded to 2.3 times of its initial volume during the first 23 h, but when diluted SF6 was used, no significant expansion was observed. Also, head positioning for the treatment of retinal tear influenced the rate of gas absorption. Moreover, the determined tolerance angle depended on the bubble and tear size. More bubble expansion and smaller retinal tear caused greater tolerance angle. For example, after 23 h, for the tear size of 2 mm the tolerance angle of using pure SF6 is 1.4 times more than that of using diluted SF6 with 80% air. Composition of the injected gas and conditions of the tear in PR may dramatically affect the gas absorption rate and gas volume. Quantifying these effects helps to predict the tolerance angle and improve treatment efficiency.

MR imaging of model drug distribution in simulated vitreous

The in vitro and in vivo characterization of intravitreal injections plays an important role in developing innovative therapy approaches. Using the established vitreous model (VM) and eye movement system (EyeMoS) the distribution of contrast agents with different molecular weight was studied in vitro. The impact of the simulated age-related vitreal liquefaction (VL) on drug distribution in VM was examined either with injection through the gel phase or through the liquid phase. For comparison the distribution was studied ex vivo in the porcine vitreous. The studies were performed in a magnetic resonance (MR) scanner. As expected, with increasing molecular weight the diffusion velocity and the visual distribution of the injected substances decreased. Similar drug distribution was observed in VM and in porcine eye. VL causes enhanced convective flow and faster distribution in VM. Confirming the importance of the injection technique in progress of VL, injection through gelatinous phase caused faster distribution into peripheral regions of the VM than following injection through liquefied phase. VM and MR scanner in combination present a new approach for the in vitro characterization of drug release and distribution of intravitreal dosage forms.

An experimental model of vitreous motion induced by eye rotations

BACKGROUND

During eye rotations the vitreous humour moves with respect to the eye globe. This relative motion has been suggested to possibly have an important role in inducing degradation of the gel structure, which might lead to vitreous liquefaction and/or posterior vitreous detachment. Aim of the present work is to study the characteristics of vitreous motion induced by eye rotations.

METHODS

We use an experimental setup, consisting of a Perspex model of the vitreous chamber that, for simplicity, is taken to have a spherical shape. The model is filled with an artificial vitreous humour, prepared as a solution of agar powder and hyaluronic acid sodium salt in deionised water, which has viscoelastic mechanical properties similar to those of the real vitreous. The model rotates about an axis passing through the centre of the sphere and velocity measurements are taken on the equatorial plane orthogonal to the axis of rotation, using an optical technique.

RESULTS

The results show that fluid viscoelasticity has a strong influence on flow characteristics. In particular, at certain frequencies of oscillation of the eye model, fluid motion can be resonantly excited. This means that fluid velocity within the domain can be significantly larger than that of the wall.

CONCLUSIONS

The frequencies for which resonant excitation occurs are within the range of possible eye rotations frequencies. Therefore, the present results suggest that resonant excitation of vitreous motion is likely to occur in practice. This, in turn, implies that eye rotations produce large stresses on the retina and within the vitreous that may contribute to the disruption of the vitreous gel structure. The present results also have implications for the choice of the ideal properties for vitreous substitute fluids.

Model-based dose calculations for COMS eye plaque brachytherapy using an anatomically realistic eye phantom

PURPOSE

To investigate the effects of the composition and geometry of ocular media and tissues surrounding the eye on dose distributions for COMS eye plaque brachytherapy with(125)I, (103)Pd, or (131)Cs seeds, and to investigate doses to ocular structures.

METHODS

An anatomically and compositionally realistic voxelized eye model with a medial tumor is developed based on a literature review. Mass energy absorption and attenuation coefficients for ocular media are calculated. Radiation transport and dose deposition are simulated using the EGSnrc Monte Carlo user-code BrachyDose for a fully loaded COMS eye plaque within a water phantom and our full eye model for the three radionuclides. A TG-43 simulation with the same seed configuration in a water phantom neglecting the plaque and interseed effects is also performed. The impact on dose distributions of varying tumor position, as well as tumor and surrounding tissue media is investigated. Each simulation and radionuclide is compared using isodose contours, dose volume histograms for the lens and tumor, maximum, minimum, and average doses to structures of interest, and doses to voxels of interest within the eye.

RESULTS

Mass energy absorption and attenuation coefficients of the ocular media differ from those of water by as much as 12% within the 20-30 keV photon energy range. For all radionuclides studied, average doses to the tumor and lens regions in the full eye model differ from those for the plaque in water by 8%-10% and 13%-14%, respectively; the average doses to the tumor and lens regions differ between the full eye model and the TG-43 simulation by 2%-17% and 29%-34%, respectively. Replacing the surrounding tissues in the eye model with water increases the maximum and average doses to the lens by 2% and 3%, respectively. Substituting the tumor medium in the eye model for water, soft tissue, or an alternate melanoma composition affects tumor dose compared to the default eye model simulation by up to 16%. In the full eye model simulations, the average dose to the lens is larger by 7%-9% than the dose to the center of the lens, and the maximum dose to the optic nerve is 17%-22% higher than the dose to the optic disk for all radionuclides. In general, when normalized to the same prescription dose at the tumor apex, doses delivered to all structures of interest in the full eye model are lowest for(103)Pd and highest for (131)Cs, except for the tumor where the average dose is highest for (103)Pd and lowest for (131)Cs.

CONCLUSIONS

The eye is not radiologically water-equivalent, as doses from simulations of the plaque in the full eye model differ considerably from doses for the plaque in a water phantom and from simulated TG-43 calculated doses. This demonstrates the importance of model-based dose calculations for eye plaque brachytherapy, for which accurate elemental compositions of ocular media are necessary.

A gradient of matrix-bound FGF-2 and perlecan is available to lens epithelial cells

Fibroblast growth factors play a key role in regulating lens epithelial cell proliferation and differentiation via an anteroposterior gradient that exists between the aqueous and vitreous humours. FGF-2 is the most important for lens epithelial cell proliferation and differentiation. It has been proposed that the presentation of FGF-2 to the lens epithelial cells involves the lens capsule as a source of matrix-bound FGF-2. Here we used immunogold labelling to measure the matrix-bound FGF-2 gradient on the inner surface of the lens capsule in flat-mounted preparations to visualize the FGF-2 available to lens epithelial cells. We also correlated FGF-2 levels with levels of its matrix-binding partner perlecan, a heparan sulphate proteoglycan (HSPG) and found the levels of both to be highest at the lens equator. These also coincided with increased levels of phosphorylated extracellular signal-regulated kinase 1 and 2 (pERK1/2) in lens epithelial cells that localised to condensed chromosomes of epithelial cells that were Ki-67 positive. The gradient of matrix-bound FGF-2 (anterior pole: 3.7 ± 1.3 particles/μm²; equator: 8.2 ± 1.9 particles/μm²; posterior pole: 4 ± 0.9 particles/μm²) and perlecan (anterior pole: 2.1 ± 0.4 particles/μm²; equator: 5 ± 2 particles/μm²; posterior pole: 1.9 ± 0.7 particles/μm²) available at the inner lens capsule surface was measured for the bovine lens. These data support the anteroposterior gradient hypothesis and provide the first measurement of the gradient for an important morphogen and its HSPG partner, perlecan, at the epithelial cell-lens capsule interface.