1
|
Mackenbrock LHB, Auffarth GU, Albrecht M, Naujokaitis T, Kessler LJ, Mayer CS, Khoramnia R. Anterior Segment Complications Following Intravitreal Injection. Klin Monbl Augenheilkd 2024; 241:917-922. [PMID: 39146576 DOI: 10.1055/a-2349-2224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Intravitreal injections (IVI s) have gained increased popularity in the past decades and are used to treat a multitude of ailments. In 2010, the total number of IVI s surpassed the number of cataract surgeries performed, making it the most common procedure in ophthalmology. As the number of injections increases, so does the number of injected-related complications. While complications in the posterior segment, such as retinal detachment or endophthalmitis, are detrimental to visual function and have therefore been well documented, IVI s can also lead to complications in the anterior segment. These include hyphema, inflammation of the sterile anterior segment (incidence rate of 0.05 to 1.1% depending on the drug), implant migration with corneal decompensation (incidence rate of 0.43%), iatrogenic lens damage (incidence rate of 0.07%), accelerated cataract formation (up to 50% for steroids and 10.9% for anti-VEGF), and an increased complication rate during subsequent cataract surgery (up to 4% per IVI). Most of these complications occur immediately and have a good prognosis if treated correctly. However, the increased risk of complications during subsequent surgery demonstrates that IVI s can also have long-term complications, a topic that needs to be explored further in future research projects.
Collapse
Affiliation(s)
| | - Gerd U Auffarth
- Department of Ophthalmology, University Hospital Heidelberg, Germany
| | - Michael Albrecht
- Department of Ophthalmology, University Hospital Heidelberg, Germany
| | - Tadas Naujokaitis
- Department of Ophthalmology, University Hospital Heidelberg, Germany
| | - Lucy J Kessler
- Department of Ophthalmology, University Hospital Heidelberg, Germany
| | - Christian S Mayer
- Department of Ophthalmology, University Hospital Heidelberg, Germany
| | - Ramin Khoramnia
- Department of Ophthalmology, University Hospital Heidelberg, Germany
| |
Collapse
|
2
|
Adrianto MF, Annuryanti F, Wilson CG, Sheshala R, Thakur RRS. In vitro dissolution testing models of ocular implants for posterior segment drug delivery. Drug Deliv Transl Res 2021; 12:1355-1375. [PMID: 34382178 PMCID: PMC9061687 DOI: 10.1007/s13346-021-01043-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 12/19/2022]
Abstract
The delivery of drugs to the posterior segment of the eye remains a tremendously difficult task. Prolonged treatment in conventional intravitreal therapy requires injections that are administered frequently due to the rapid clearance of the drug molecules. As an alternative, intraocular implants can offer drug release for long-term therapy. However, one of the several challenges in developing intraocular implants is selecting an appropriate in vitro dissolution testing model. In order to determine the efficacy of ocular implants in drug release, multiple in vitro test models were emerging. While these in vitro models may be used to analyse drug release profiles, the findings may not predict in vivo retinal drug exposure as this is influenced by metabolic and physiological factors. This review considers various types of in vitro test methods used to test drug release of ocular implants. Importantly, it discusses the challenges and factors that must be considered in the development and testing of the implants in an in vitro setup.
Collapse
Affiliation(s)
- Muhammad Faris Adrianto
- School of Pharmacy, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.,Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Universitas Airlangga, Surabaya, East Java, 60115, Indonesia
| | - Febri Annuryanti
- School of Pharmacy, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.,Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Universitas Airlangga, Surabaya, East Java, 60115, Indonesia
| | - Clive G Wilson
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, Scotland
| | - Ravi Sheshala
- Department of Pharmaceutics, Faculty of Pharmacy, Universiti Teknologi MARA Selangor, Puncak Alam Campus, 42300, Bandar Puncak Alam, Kuala Selangor, Malaysia
| | - Raghu Raj Singh Thakur
- School of Pharmacy, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
| |
Collapse
|
3
|
Ong J, Davidoss NH, Bhosale A, Balaratnasingam C. Spontaneous extrusion of a dexamethasone intravitreal implant (Ozurdex). BMJ Case Rep 2020; 13:13/11/e235102. [PMID: 33148568 PMCID: PMC7640474 DOI: 10.1136/bcr-2020-235102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
A 59-year-old man with diabetic macular oedema was treated with a dexamethasone intravitreal implant (Ozurdex) to his right eye. Immediately after injection, the implant was noted to have extruded into the perilimbal subconjunctival space. The remnants of the implant were expeditiously removed the following day to avoid corneal decompensation and permanent corneal oedema. Endothelial decompensation secondary to the migration of dexamethasone implants into the subconjunctival space or anterior chamber is a recognised complication of Ozurdex injection. The patient recovered well postoperatively with no further complications. He was planned for a new Ozurdex implant 1 month later.
Collapse
Affiliation(s)
- Jessica Ong
- Ophthalmology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | | | - Anant Bhosale
- Ophthalmology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Retina and Vitreous, Aravind Eye Hospital Coimbatore, Coimbatore, India
| | - Chandrakumar Balaratnasingam
- Ophthalmology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Lions Eye Institute, Nedlands, Western Australia, Australia
| |
Collapse
|
4
|
Bayat AH, Karataş G, Kurt MM, Elçioğlu MN. The corneal effects of intravitreal dexamethasone implantation. Ther Adv Ophthalmol 2020; 12:2515841420947544. [PMID: 32844147 PMCID: PMC7418223 DOI: 10.1177/2515841420947544] [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: 05/12/2020] [Accepted: 07/13/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives: To evaluate the corneal effects of the intravitreal dexamethasone implantation using corneal topography and specular microscopy. Material and methods: 27 eyes of the 27 patients who received a single intravitreal dexamethasone implantation dose for diabetic macular edema were enrolled in this study. Sirius topography and EM-3000 specular microscopic examinations were performed at the initial examination (baseline), and then on the first day, during the first week, and 1 month after IDI. Changes in corneal parameters were investigated. Results: The mean age was 58.66 ± 6.59 years. 15 patients were men, and 12 were women. The mean disease duration was 12.2 ± 2.4 months, and mean glycosylated hemoglobin (HbA1c) was 7.2 ± 1.1. After dexamethasone injection, the mean central corneal thickness, endothelial cell density, and coefficient variation of cell area presented a statistically significant decrease (p < 0.05). Anterior segment parameters, such as anterior chamber depth, iridocorneal angle, sim K1 and K2 keratometry, pupillary diameter, horizontal visible iris diameter, and corneal astigmatism did not change (p > 0.05). Conclusion: Intravitreal dexamethasone implantation affects corneal endothelial cell structure but does not appear to affect corneal topography parameters.
Collapse
Affiliation(s)
- Alper Halil Bayat
- Department of Ophthalmology, Esenler Hospital, Medipol University, APT: 5 Bahceler, AVE Esenler, Istanbul 34250, Turkey
| | - Gamze Karataş
- Department of Ophthalmology, Okmeydanı Research &Traning Hospital, University of Health Sciences, İstanbul, Turkey
| | | | - Mustafa Nuri Elçioğlu
- Department of Ophthalmology, Okmeydanı Research &Traning Hospital, University of Health Sciences, İstanbul, Turkey
| |
Collapse
|
5
|
Cheng KJ, Hsieh CM, Nepali K, Liou JP. Ocular Disease Therapeutics: Design and Delivery of Drugs for Diseases of the Eye. J Med Chem 2020; 63:10533-10593. [PMID: 32482069 DOI: 10.1021/acs.jmedchem.9b01033] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The ocular drug discovery field has evidenced significant advancement in the past decade. The FDA approvals of Rhopressa, Vyzulta, and Roclatan for glaucoma, Brolucizumab for wet age-related macular degeneration (wet AMD), Luxturna for retinitis pigmentosa, Dextenza (0.4 mg dexamethasone intracanalicular insert) for ocular inflammation, ReSure sealant to seal corneal incisions, and Lifitegrast for dry eye represent some of the major developments in the field of ocular therapeutics. A literature survey also indicates that gene therapy, stem cell therapy, and target discovery through genomic research represent significant promise as potential strategies to achieve tissue repair or regeneration and to attain therapeutic benefits in ocular diseases. Overall, the emergence of new technologies coupled with first-in-class entries in ophthalmology are highly anticipated to restructure and boost the future trends in the field of ophthalmic drug discovery. This perspective focuses on various aspects of ocular drug discovery and the recent advances therein. Recent medicinal chemistry campaigns along with a brief overview of the structure-activity relationships of the diverse chemical classes and developments in ocular drug delivery (ODD) are presented.
Collapse
Affiliation(s)
- Kuei-Ju Cheng
- School of Pharmacy, College of Pharmacy, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan.,Department of Pharmacy, Taipei Municipal Wanfang Hospital, Taipei Medical University, No. 111, Section 3, Xing-Long Road, Taipei 11696, Taiwan
| | - Chien-Ming Hsieh
- School of Pharmacy, College of Pharmacy, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan
| | - Kunal Nepali
- School of Pharmacy, College of Pharmacy, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan
| | - Jing-Ping Liou
- School of Pharmacy, College of Pharmacy, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan
| |
Collapse
|
6
|
Lee CY, Chen HT, Lin HY, Chen HC, Yeung L, Hwang YS, Chen KJ, Wu WC, Lai CC. Changes in corneal endothelial density following scleral buckling surgery for rhegmatogenous retinal detachment: a retrospective cross-sectional study. BMC Ophthalmol 2019; 19:3. [PMID: 30611234 PMCID: PMC6321691 DOI: 10.1186/s12886-018-1015-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the effect of scleral buckling (SB) on the morphology and density of human corneal endothelial cells (HCEC). METHODS In this retrospective cross-sectional study, 26 patients who had undergone SB due to rhegmatogenous retinal detachment were enrolled, in which 15 patients received encircling while the other 11 segment types of SB. The postoperative status of affected eye, preoperative status of affected eye, and the contralateral healthy eye was served as the study, control and contralateral groups. The images of the corneal endothelium was obtained by specular microscopy at least three months postoperatively and analyzed. RESULTS Postoperative best-corrected visual acuity of the study group was worse than that of another two groups (P < 0.001) while intraocular pressure and biometry data were similar. The mean cell area and standard deviation were larger in the study group while the coefficient of variation revealed no difference. The study group manifested a lower endothelial cell density than that of the control and the contralateral (P < 0.001) groups. Concerning the percentage of hexagonal cells, the study group showed a lower hexagonality than the control group (P = 0.04). No difference of the endothelial morphology was found between the segmental subgroup and the encircling subgroup, nor was a significant difference about endothelial cell loss found in the study group with different measurement interval. CONCLUSIONS Scleral buckling leads to short-term decreased endothelial cell density and hexagonality, while the rest of morphological features remain unchanged. Moreover, both the segmental and encircling SB procedures yield similar postoperative HCEC status.
Collapse
Affiliation(s)
- Chia-Yi Lee
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan.,Department of Optometry, College of Medicine and Life Science, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Hung-Ta Chen
- Department of Internal Medicine, Taipei City Hospital- Heping Branch, Taipei, Taiwan
| | - Hung-Yu Lin
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Optometry, Chung Shan Medical University, Taichung, Taiwan.,Department of Optometry, Yuanpei University of Medical Technology, Hsinchu, Taiwan.,Department of Exercise and Health Promotion, Chung Chou University of Science and Technology, Changhua, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan, 33305, Taiwan.
| | - Ling Yeung
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan, 33305, Taiwan.
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| |
Collapse
|