New drug-eluting lenses to be applied as bandages after keratoprosthesis implantation

Drug-eluting contact lenses: Progress, challenges, and prospects

Topical ophthalmic solutions (eye drops) are becoming increasingly popular in treating and preventing ocular diseases for their safety, noninvasiveness, and ease of handling. However, the static and dynamic barriers of eyes cause the extremely low bioavailability (<5%) of eye drops, making ocular therapy challenging. Thus, drug-eluting corneal contact lenses (DECLs) have been intensively investigated as a drug delivery device for their attractive properties, such as sustained drug release and improved bioavailability. In order to promote the clinical application of DECLs, multiple aspects, i.e., drug release and penetration, safety, and biocompatibility, of these drug delivery systems were thoroughly examined. In this review, we systematically discussed advances in DECLs, including types of preparation materials, drug-loading strategies, drug release mechanisms, strategies for penetrating ocular barriers, in vitro and in vivo drug delivery and penetration detection, safety, and biocompatibility validation methods, as well as challenges and future perspectives.

Polysaccharides in contact lenses: From additives to bulk materials

As the number of applications has increased, so has the demand for contact lenses comfort. Adding polysaccharides to lenses is a popular way to enhance comfort for wearers. However, this may also compromise some lens properties. It is still unclear how to balance the variation of individual lens parameters in the design of contact lenses containing polysaccharides. This review provides a comprehensive overview of how polysaccharide addition impacts lens wear parameters, such as water content, oxygen permeability, surface wettability, protein deposition, and light transmittance. It also examines how various factors, such as polysaccharide type, molecular weight, amount, and mode of incorporation into lenses modulate these effects. Polysaccharide addition can improve some wear parameters while reducing others depending on the specific conditions. The optimal method, type, and amount of added polysaccharides depend on the trade-off between various lens parameters and wear requirements. Simultaneously, polysaccharide-based contact lenses may be a promising option for biodegradable contact lenses as concerns regarding environmental risks associated with contact lens degradation continue to increase. It is hoped that this review will shed light on the rational use of polysaccharides in contact lenses to make personalized lenses more accessible.

Soft Contact Lenses as Drug Delivery Systems: A Review

This review describes the role of contact lenses as an innovative drug delivery system in treating eye diseases. Current ophthalmic drug delivery systems are inadequate, particularly eye drops, which allow about 95% of the active substance to be lost through tear drainage. According to the literature, many interdisciplinary studies have been carried out on the ability of contact lenses to increase the penetration of topical therapeutic agents. Contact lenses limit drug loss by releasing the medicine into two layers of tears on either side of the contact lens, eventually extending the time of contact with the ocular surface. Thanks to weighted soft contact lenses, a continuous release of the drug over an extended period is possible. This article reviewed the various techniques to deliver medications through contact lenses, examining their advantages and disadvantages. In addition, the potential of drug delivery systems based on contact lenses has been extensively studied.

Corneal delivery of moxifloxacin and dexamethasone combination using drug-eluting mucoadhesive contact lens to treat ocular infections

The important causes of loss of vision are ocular infections, including keratitis and conjunctivitis. Attaining an adequate concentration of topically applied antibiotics to prevent or treat infections within the cornea is challenging. The study aimed to design and develop a drug-eluting polymeric contact lens for the effective delivery of moxifloxacin (MF) and dexamethasone (DM). The polymeric contact lens was prepared using chitosan, glycerol, and polyethylene glycol. MF and DM were loaded into the contact lens, both separately and in combination. The MF and DM loaded contact lenses were characterized for thickness, swelling index, surface topography, and mucoadhesion strength. Furthermore, studies were performed to understand the in vitro drug release behavior, ex vivo corneal permeation, and in vitro and in vivo antimicrobial activity. The drug-loaded contact lens was compared with the standard drug solutions. The physical characteristics of the polymeric contact lens were similar to the commercially available contact lens. Compared to the topically applied standard drug solutions, the drug-loaded contact lens showed significantly (p < 0.05) greater corneal drug distribution after 24 h incubation. In vitro and in vivo antimicrobial activity of the MF loaded contact lens was superior to the standard drug solution. In vivo drug distribution studies showed greater tissue concentration of MF in cornea, sclera, and aqueous humor with contact lens application compared with drug solutions. Overall, the polymeric contact lens was efficient in delivering MF and DM at required therapeutic concentrations. The findings from the present study show that drug-eluting contact lenses could be used in post-operative conditions to prevent ocular infections.

Contact Lenses as Drug Delivery System for Glaucoma: A Review

Glaucoma is an optical neuropathy associated to a progressive degeneration of retinal ganglion cells with visual field loss and is the main cause of irreversible blindness in the world. The treatment has the aim to reduce intraocular pressure. The first therapy option is to instill drugs on the ocular surface. The main limitation of this is the reduced time of the drug staying on the cornea. This means that high doses are required to ensure its therapeutic effect. A drug-loaded contact lens can diffuse into the post lens tear film in a constant and prolonged flow, resulting in an increased retention of the drug on the surface of the cornea for up to 30 min and thus providing a higher drug bioavailability, increasing the therapeutic efficacy, reducing the amount of administered drug, and thereby provoking fewer adverse events. Several different systems of drug delivery have been studied in recent decades; ranging from more simple methods of impregnating the lenses, such as soaking, to more complex ones, such as molecular imprinting have been proposed. Moreover, different drugs, from those already commercially available to new substances such as melatonin have been studied to improve the glaucoma treatment efficacy. This review describes the role of contact lenses as an innovative drug delivery system to treat glaucoma.

Boston Type 1 Keratoprosthesis: Updated Perspectives

The use of Boston type 1 keratoprosthesis (BKPro) has significantly increased worldwide. It is no longer considered a procedure of last resort but a reasonable option for patients with otherwise poor prognosis for a traditional penetrating keratoplasty. BKPro was approved by the Food and Drug Administration in 1992 for bilateral severe corneal blindness due to multiple corneal transplant failure. Over the years, indications have extended beyond recurrent immunologic rejection to include other conditions such as chemical injury and other causes of bilateral limbal stem cell deficiency, extensive corneal neovascularization, neurotrophic corneas and hypotony, among others. Numerous advances in the design of the BKPro, improvement of preoperative, intraoperative and postoperative management have resulted in favorable outcomes and a reduction in postoperative complications. Accordingly, many studies have shown that implantation of this device is highly effective in restoring vision with very good short-term outcomes. However, due to the lifetime risk of sight-threatening complications after BKPro implantation, a longer follow-up period should provide outcomes that are more realistic. In this review, the authors examined only the results of publications with an average of at least 2 years of follow-up. The overall intermediate to long-term visual outcomes and retention rate in BKPro seem to be favorable. However, autoimmune diseases and cicatrizing conditions continue to show a higher incidence of postoperative complications that require further management.

S, Akshara MR, N. K, Zaidi ZS, Iqbal SF, Misra SK. Advances in chemistry and composition of soft materials for drug releasing contact lenses

Ocular drug delivery has always been a challenging feat to achieve in the field of medical sciences. One of the existing methods of non-invasive ocular drug delivery is the use of eye drops. However, drugs administered through these formulations have low bioavailability in the ocular system. This limitation can been overcome by using contact lenses as drug delivery vehicles. According to USA FDA definitions they can be categorized into two main categories-hard and soft contact lenses. Based on the material properties, hard contact lenses are mostly produced from polymers of acrylate monomers such as MMA (methyl methacrylate). These have the least water retention capacity, thereby, having minimal ability to diffuse oxygen into the corneal layer and are not ideal for long term use. Soft material contact lenses are flexible and are mainly hydrogel based. They have higher water retention capacities as compared to rigid contact lenses, which gives them the ability to transmit oxygen to the corneal layer. These hydrogel based soft materials are mainly produced from polymers of acrylate monomers such as HEMA (hydroxyethyl methacrylate) and found to be better for drug delivery contact lenses. These polymer-based soft materials have been efficiently modified in terms of their chemistry to achieve diverse physicochemical properties to produce efficient ocular drug delivery systems. However, complications such as drug leaching during storage and distribution, sterilisation, preservation of integrity of the lens and the possibility of surface roughness due to the incorporated drug molecules still need to be optimised. This review highlights the chemistries of various polymeric molecules through which physicochemical properties can be modified to achieve optimum drug loading and sustained release of the drug for application in the ocular system.

Contact lens as controllable route for ocular drug delivery.

Hydrogel-based ocular drug delivery systems: Emerging fabrication strategies, applications, and bench-to-bedside manufacturing considerations

The physiological barriers of the eye pose challenges to the delivery of the array of therapeutics for ocular diseases. Hydrogels have been widely explored for medical applications and introduce possible solutions to overcoming the medication challenges of the ocular environment. While the innovations in drug encapsulation and release mechanisms, biocompatibility, and treatment duration have become highly sophisticated, the challenge of widespread application of hydrogel formulations in the clinic is still apparent. This article reviews the latest hydrogel formulations and their associated chemistries for use in ocular therapies, spanning from external anterior to internal posterior regions of the eye in order to evaluate the state of recent research. This article discusses the utility of hydrogels in soft contact lens, wound dressings, intraocular lens, vitreous substitutes, vitreous drug release hydrogels, and cell-based therapies for regeneration. Additional focus is placed on the pre-formulation, formulation, and manufacturing considerations of the hydrogels based on individual components (polymer chains, linkers, and therapeutics), final hydrogel product, and required preparations for clinical/commercial applications, respectively.

Recent Trends in Advanced Contact Lenses

Exploiting contact lenses for ocular drug delivery is an emerging field in the area of biomedical engineering and advanced healthcare materials. Despite all the research conducted in this area, still, new technologies are in their early stages of the development, and more work must be done in terms of clinical trials to commercialize these technologies. A great challenge in using contact lenses for drug delivery is to achieve a prolonged drug release profile within the therapeutic range for various eye-related problems and diseases. In general, desired release kinetics to avoid the initial burst release is the zero-order kinetics within the therapeutic range. This review highlights the new technologies developed to achieve efficient and extended drug delivery. It also provides an overview of the materials and methods for fabrication of contact lenses and their mechanical and optical properties.

Ocular adhesives: Design, chemistry, crosslinking mechanisms, and applications

Closure of ocular wounds after an accident or surgery is typically performed by suturing, which is associated with numerous potential complications, including suture breakage, inflammation, secondary neovascularization, erosion to the surface and secondary infection, and astigmatism; for example, more than half of post-corneal transplant infections are due to suture related complications. Tissue adhesives provide promising substitutes for sutures in ophthalmic surgery. Ocular adhesives are not only intended to address the shortcomings of sutures, but also designed to be easy to use, and can potentially minimize post-operative complications. Herein, recent progress in the design, synthesis, and application of ocular adhesives, along with their advantages, limitations, and potential are discussed. This review covers two main classes of ocular adhesives: (1) synthetic adhesives based on cyanoacrylates, polyethylene glycol (PEG), and other synthetic polymers, and (2) adhesives based on naturally derived polymers, such as proteins and polysaccharides. In addition, different technologies to cover and protect ocular wounds such as contact bandage lenses, contact lenses coupled with novel technologies, and decellularized corneas are discussed. Continued advances in this area can help improve both patient satisfaction and clinical outcomes.

Pharmaceutical applications of chitosan

Chitosan (CS) is a linear polysaccharide which is achieved by deacetylation of chitin, which is the second most plentiful compound in nature, after cellulose. It is a linear copolymer of β-(1 → 4)-linked 2-acetamido-2-deoxy-β-d-glucopyranose and 2-amino-2-deoxy-β-d-glucopyranose. It has appreciated properties such as biocompatibility, biodegradability, hydrophilicity, nontoxicity, high bioavailability, simplicity of modification, favorable permselectivity of water, outstanding chemical resistance, capability to form films, gels, nanoparticles, microparticles and beads as well as affinity to metals, proteins and dyes. Also, the biodegradable CS is broken down in the human body to safe compounds (amino sugars) which are easily absorbed. At present, CS and its derivatives are broadly investigated in numerous pharmaceutical and medical applications including drug/gene delivery, wound dressings, implants, contact lenses, tissue engineering and cell encapsulation. Besides, CS has several OH and NH₂ functional groups which allow protein binding. CS with a deacetylation degree of ~50% is soluble in aqueous acidic environment. While CS is dissolved in acidic medium, its amino groups in the polymeric chains are protonated and it becomes cationic which allows its strong interaction with different kinds of molecules. It is believed that this positive charge is responsible for the antimicrobial activity of CS through the interaction with the negatively charged cell membranes of microorganisms. This review presents properties and numerous applications of chitosan-based compounds in drug delivery, gene delivery, cell encapsulation, protein binding, tissue engineering, preparation of implants and contact lenses, wound healing, bioimaging, antimicrobial food additives, antibacterial food packaging materials and antibacterial textiles. Moreover, some recent molecular dynamics simulations accomplished on the pharmaceutical applications of chitosan were presented.

A comprehensive review on contact lens for ophthalmic drug delivery

With the prevalence of electronic devices and an aging population, the number of people affected with eye disease is increasing year by year. In spite of a large number of eye drops on the market, most of them do not perform sufficiently, due to rapid clearance mechanisms and ocular barriers. To enhance drug delivery to the eye, a number of novel formulations for ocular diseases have been investigated over recent decades, aiming to increase drug retention and permeation while also allowing for sustained drug release over prolonged periods. The contact lens, initially used to correct visual acuity and beautify female eyes, is one such novel formulation with outstanding potential. Recently, contact lenses have been extensively used for ocular drug delivery to enhance ocular bioavailability and reduce side effects, and are particularly suitable for the treatment of chronic diseases, and thus are of interest to ophthalmic scientists. This review summarizes contact lens classification, methods of preparation, strategies for integrating drugs into lenses, in vitro and in vivo studies, and clinical applications. This review also discusses the current state of ocular drug therapy and provides an outlook for future therapeutic opportunities in the field of ocular drug delivery.

A Novel Peptide Hydrogel for an Antimicrobial Bandage Contact Lens

A peptide hydrogel with an antimicrobial activity is developed as a bandage contact lens. The antimicrobial activity is enhanced with the addition of the biomolecules penicillin G or poly-ε-lysine and is positive against Staphylococcus aureus and Escherichia coli. The lens is also noncytotoxic toward a human corneal epithelial cell line and as a consequence is of great potential as a drug-eluting bandage lens replacing conventional corneal ulcer treatment.

A review on therapeutic contact lenses for ocular drug delivery

Contact lenses for ophthalmic drug delivery have become very popular, due to their unique advantages like extended wear and more than 50% bioavailability. To achieve controlled and sustained drug delivery from contact lenses, researchers are working on various systems like polymeric nanoparticles, microemulsion, micelle, liposomes, use of vitamin E, etc. Numerous scientists are working on different areas of therapeutic contact lenses to treat ocular diseases by implementing techniques like soaking method, molecular imprinting, entrapment of drug-laden colloidal nanoparticles, drug plate/film, ion ligand polymeric systems, supercritical fluid technology, etc. Though sustained drug delivery was achieved using contact lens, the critical properties such as water content, tensile strength (mechanical properties), ion permeability, transparency and oxygen permeability were altered, which limit the commercialization of therapeutic contact lenses. Also issues like drug stability during processing/fabrication (drug integrity test), zero order release kinetics (prevent burst release), drug release during monomer extraction step after fabrication (to remove un-reacted monomers), protein adherence, drug release during storage in packaging solution, shelf life study, cost-benefit analysis, etc. are still to be addressed. This review provides an expert opinion on different methodology to develop therapeutic contact lenses with special remark of their advantages and limitations.