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Jia T, Stapleton F, Iqbal F, Showyin J, Roy D, Roy M, Tan J. Comparison of eye drop retention time using fluorophotometry in three commercially available lubricant eye drops. Optom Vis Sci 2024:00006324-990000000-00222. [PMID: 39190794 DOI: 10.1097/opx.0000000000002172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024] Open
Abstract
SIGNIFICANCE This is the first study to evaluate the retention time of lubricating eye drops containing various concentrations of sodium hyaluronate using fluorophotometry in a symptomatic dry eye population. Information regarding eye drop retention may be useful for eye care practitioners to assist in the selection of more effective treatments for managing dry eye. PURPOSE This study aimed to use fluorophotometry to compare retention time on the ocular surface of three commercially available lubricating eye drops, each containing varying concentrations of sodium hyaluronic acid (HA), and their effects on tear film stability post-instillation in a population with symptoms of dry eye. METHODS Adults with symptoms of dry eye (Ocular Surface Disease Index score, >12) were enrolled in this prospective, double-masked comparison of eye drops containing 0.15% HA-hydroxypropyl guar (HPGuar), 0.2% HA, and 0.1% HA. Participants were randomized to the eye drop order and the study eye under evaluation. Each eye drop was admixed with a fluorescent tracer (70-kDa fluorescein isothiocyanate-dextran) at 10% wt/vol, and 10 μL volume was instilled for each evaluation. A fluorophotometer was used to measure the time for the tracer signal to return to baseline. Fluorescein tear breakup time was measured following fluorophotometry assessment. RESULTS Retention time for 0.15% HA-HPGuar and 0.2% HA was significantly longer compared with 0.1% HA (p=0.02 and p=0.03). Fluorescein tear breakup time was significantly longer for the 0.15% HA-HPGuar eye drop compared with both the 0.1% HA eye drop (p=0.01) and 0.2% HA eye drop (p=0.003). CONCLUSIONS Retention time on the ocular surface of the two eye drops containing higher concentrations of HA was longer than the eye drop with the lowest concentration of HA. The tear film was also more stable with the 0.15% HA-HPGuar eye drop compared with the eye drops containing HA alone, which may be attributable to the other components in the 0.15% HA-HPGuar eye drop.
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Affiliation(s)
- Tianni Jia
- School of Optometry and Vision Science, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Fatima Iqbal
- School of Optometry and Vision Science, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Jared Showyin
- School of Optometry and Vision Science, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Dibyendu Roy
- School of Optometry and Vision Science, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Maitreyee Roy
- School of Optometry and Vision Science, University of New South Wales Sydney, Sydney, New South Wales, Australia
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Xu W, Zhao X, Jin H, Jin H, Jia F, Jiang L, Li Z. A randomized controlled trial involving college student: Comparing 0.15% hyaluronic acid with 0.05% cyclosporine A and 3% diquafosol sodium in the Treatment of Dry Eye. Medicine (Baltimore) 2023; 102:e34923. [PMID: 37682142 PMCID: PMC10489517 DOI: 10.1097/md.0000000000034923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/03/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND To compare the efficacy of 0.15% hyaluronic acid (HA), 0.05% cyclosporine A (CsA) and 3% diquafosol sodium (DQS) ophthalmic solution for the treatment of moderate-to-severe dry eye disease (DED) in college students and the effect on inflammatory factors in tears. METHODS This was a prospective, randomized, multicenter trial. A total of 282 college students diagnosed with moderate-to-severe DED between October 2, 2022 and March 1, 2023 were included. A total of 282 patients were randomized to treatment in the group of 0.15% HA or 0.05% CsA or 3% DQS in a 1:1:1 assignment. There was a main end point which is the variations in the corneal staining score to determine non-inferiority of 0.15% HA. Secondary target end points were ocular surface disease index score, Schirmer test, tear meniscus height and tear film breakup time. In addition, the inflammatory factor levels of Interleukin-1β, Interleukin-6, transforming growth factor-β1 in tears were measured. Effectiveness was assessed at baseline, 4- and 12-weeks. RESULTS In our analysis, the average change from baseline in corneal staining score confirmed non-inferiority of 0.15% HA to 0.05% CsA and 3% DQS and manifested obvious improvement of all groups as well (P < .05). Values for ocular surface disease index score, Schirmer test, tear meniscus height and tear film breakup time showed obvious improvements in all groups (P < .05), however, the difference intergroup was not statistically significant. Value for inflammatory factor was significant improvement across all groups, although inflammatory factor scores in the 0.05% CsA group showed a clear trend of better improvement at 12 weeks compared with 0.15% HA groups (P < .01). No serious adverse reactions were observed. CONCLUSIONS College students taking 0.15% HA had clinically and statistically significant improvement in corneal staining score and other indicators, but it was inferior to 0.05% CsA in anti-inflammatory therapy for moderate to severe DED. However, 0.15% HA is still an effective, safe and well-tolerated treatment option that may offer additional benefits in terms of convenience and compliance.
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Affiliation(s)
- Wenhao Xu
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji, China
- Yanbian University, Yanji, China
| | - Xinrui Zhao
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji, China
| | - Haiyan Jin
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji, China
- Department of Ophthalmology, Fuzhi Hospital of Yanbian University, Yanji, China
| | - Hua Jin
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji, China
| | - Fali Jia
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji, China
| | - Lilan Jiang
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji, China
| | - Zhengri Li
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji, China
- Yanbian University, Yanji, China
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Lee H, Noh H. Advancements in Nanogels for Enhanced Ocular Drug Delivery: Cutting-Edge Strategies to Overcome Eye Barriers. Gels 2023; 9:718. [PMID: 37754399 PMCID: PMC10529109 DOI: 10.3390/gels9090718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/29/2023] [Accepted: 09/02/2023] [Indexed: 09/28/2023] Open
Abstract
Nanomedicine in gel or particle formation holds considerable potential for enhancing passive and active targeting within ocular drug delivery systems. The complex barriers of the eye, exemplified by the intricate network of closely connected tissue structures, pose significant challenges for drug administration. Leveraging the capability of engineered nanomedicine offers a promising approach to enhance drug penetration, particularly through active targeting agents such as protein peptides and aptamers, which facilitate targeted release and heightened bioavailability. Simultaneously, DNA carriers have emerged as a cutting-edge class of active-targeting structures, connecting active targeting agents and illustrating their potential in ocular drug delivery applications. This review aims to consolidate recent findings regarding the optimization of various nanoparticles, i.e., hydrogel-based systems, incorporating both passive and active targeting agents for ocular drug delivery, thereby identifying novel mechanisms and strategies. Furthermore, the review delves into the potential application of DNA nanostructures, exploring their role in the development of targeted drug delivery approaches within the field of ocular therapy.
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Affiliation(s)
| | - Hyeran Noh
- Department of Optometry, Seoul National University of Science and Technology, Gongnung-ro 232, Nowon-gu, Seoul 01811, Republic of Korea;
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Bedos L, Allbaugh RA, Roy M, Kubai MA, Sebbag L. Precorneal retention time of ocular lubricants measured with fluorophotometry in healthy dogs. Vet Ophthalmol 2023; 26 Suppl 1:81-88. [PMID: 36749146 DOI: 10.1111/vop.13065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/18/2022] [Accepted: 01/20/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Determine the precorneal retention time of five different ocular lubricants commonly used in dogs. ANIMALS STUDIED Six healthy Beagle dogs (n = 12 eyes). PROCEDURES Five ocular lubricants were studied: Artificial Tears Solution® (1.4% polyvinyl alcohol), I-Drop® Vet Plus (0.25% hyaluronate), Optixcare® Eye Lube Plus (0.25% hyaluronate), Systane® Ultra (0.4% polyethylene glycol 400 and 0.3% propylene glycol), and Artificial Tears Ointment® (mineral oil/white petrolatum). Each lubricant was mixed with 10% sodium fluorescein to achieve 1% fluorescein formulations. Following topical administration of 35 mg in each eye, tear fluid was collected with capillary tubes at selected times (0, 1, 5, 10, 20, 30, 40, 50, 60, 90, 120, 180 min) and fluorescein concentrations were measured with a computerized scanning ocular fluorophotometer. RESULTS Tear fluorescence was significantly greater with Artificial Tears Ointment® compared with other lubricant formulations from 1 to 20 min post-administration. Median (range) precorneal retention times were significantly different among the 5 lubricants, ranging from 40 minutes (20-90 min) for Artificial Tears Ointment®, 35 min (20-90 min) for Systane® Ultra, 30 min (10-60 min) for I-Drop® Vet Plus, 25 min (10-60 min) for Optixcare® Eye Lube Plus, and 10 min (10-20 min) for Artificial Tears Solution®. Precorneal retention time was significantly lower for Artificial Tears Solution® compared with the other 4 formulations. CONCLUSIONS This study established normative data for the retention time of common lubricants on the ocular surface of dogs, which may be used to guide clinicians with their choice of lubricant and frequency of administration.
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Affiliation(s)
- L Bedos
- Department of Veterinary Clinical Sciences, Iowa State University, College of Veterinary Medicine, Ames, Iowa, USA
| | - R A Allbaugh
- Department of Veterinary Clinical Sciences, Iowa State University, College of Veterinary Medicine, Ames, Iowa, USA
| | - M Roy
- Department of Veterinary Clinical Sciences, Iowa State University, College of Veterinary Medicine, Ames, Iowa, USA
| | - M A Kubai
- Department of Veterinary Clinical Sciences, Iowa State University, College of Veterinary Medicine, Ames, Iowa, USA
| | - L Sebbag
- Department of Veterinary Clinical Sciences, Iowa State University, College of Veterinary Medicine, Ames, Iowa, USA.,Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
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Labetoulle M, Mortemousque B. Performance and Safety of a Sodium Hyaluronate Tear Substitute with Polyethylene Glycol in Dry Eye Disease: A Multicenter, Investigator-Masked, Randomized, Noninferiority Trial. J Ocul Pharmacol Ther 2022; 38:607-616. [PMID: 36269661 DOI: 10.1089/jop.2022.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To compare the performance and safety of 2 tear substitutes containing sodium hyaluronate (SH); one containing 0.15% SH and polyethylene glycol (PEG) 8000, and the other containing 0.18% SH. Methods: In this multicenter, randomized, investigator-masked, noninferiority trial, 83 patients with moderate or severe dry eye disease underwent a 2-week washout, and were then randomly assigned (1:1) to receive SH plus PEG tear substitute (n = 45) or comparator SH tear substitute (n = 38) 3-6 times daily for 3 months. The primary performance endpoint was the change from baseline in the ocular surface fluorescein staining (OSFS) score on day 28 in the per-protocol (PP) population, according to the 15-point Oxford Scheme, with a noninferiority margin of 2. Results: Both groups improved significantly in terms of signs and symptoms. Among the 78 patients without major protocol deviations (the PP population), the OSFS score decreased by 2.9 ± 2.0 on day 28 from 5.4 ± 1.3 at baseline in the SH plus PEG group and by 2.3 ± 2.2 from 5.2 ± 1.4 in the comparator group (95% confidence interval of the difference: -1.2 to 0.3), demonstrating noninferiority. On day 90, the improvement in OSFS scores was significantly greater in the SH plus PEG group (P = 0.0002). The safety profiles were satisfactory in both groups. Conclusion: SH plus PEG tear substitute was noninferior to SH tear substitute in the studied population and may provide additional benefits in the long term. ClinicalTrials.gov ID: NCT02975102.
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Affiliation(s)
- Marc Labetoulle
- Service d'Ophtalmologie, Hôpital Bicêtre, APHP, Université Paris Sud, Le Kremlin-Bicêtre, France.,IDMIT Infrastructure, CEA, Université Paris-Saclay, Inserm U1184, Fontenay-aux-Roses, France
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Yu Y, Chow DWY, Lau CML, Zhou G, Back W, Xu J, Carim S, Chau Y. A bioinspired synthetic soft hydrogel for the treatment of dry eye. Bioeng Transl Med 2021; 6:e10227. [PMID: 34589602 PMCID: PMC8459603 DOI: 10.1002/btm2.10227] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 11/30/2022] Open
Abstract
Natural soft hydrogels are unique elastic soft materials utilized by living organisms for protecting delicate tissues. Under a theoretical framework derived from the Blob model, we chemically crosslinked high molecular weight hyaluronic acid at a concentration close to its overlap concentration (c*), and created synthetic soft hydrogels that exhibited unique rheological properties similar to a natural soft hydrogel: being dominantly elastic under low shear stress while being viscous when the stress is above a small threshold. We explored a potential application of the hyaluronic acid-based soft hydrogel as a long-acting ocular surface lubricant and evaluated its therapeutic effects for dry eye. The soft hydrogel was found to be biocompatible after topical instillation on experimental animals' and companion dogs' eyes. In a canine clinical study, twice-a-day ocular instillation of the soft hydrogel in combination with cyclosporine for 1 month improved the clinical signs in more than 65% of dog patients previously unresponsive to cyclosporine treatment.
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Affiliation(s)
- Yu Yu
- Chemical and Biological EngineeringHong Kong University of Science and TechnologyHong KongChina
- Pleryon Therapeutics LimitedShenzhenChina
| | | | - Chi Ming Laurence Lau
- Chemical and Biological EngineeringHong Kong University of Science and TechnologyHong KongChina
- The Hong Kong University of Science and Technology Shenzhen Research InstituteShenzhenChina
| | | | - Woojin Back
- Chemical and Biological EngineeringHong Kong University of Science and TechnologyHong KongChina
| | - Jing Xu
- Chemical and Biological EngineeringHong Kong University of Science and TechnologyHong KongChina
| | - Sean Carim
- Chemical and Biological EngineeringHong Kong University of Science and TechnologyHong KongChina
| | - Ying Chau
- Chemical and Biological EngineeringHong Kong University of Science and TechnologyHong KongChina
- The Hong Kong University of Science and Technology Shenzhen Research InstituteShenzhenChina
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CLEAR - Contact lens wettability, cleaning, disinfection and interactions with tears. Cont Lens Anterior Eye 2021; 44:157-191. [DOI: 10.1016/j.clae.2021.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 12/15/2022]
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Grassiri B, Zambito Y, Bernkop-Schnürch A. Strategies to prolong the residence time of drug delivery systems on ocular surface. Adv Colloid Interface Sci 2021; 288:102342. [PMID: 33444845 DOI: 10.1016/j.cis.2020.102342] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022]
Abstract
Ocular diseases may be treated via different routes of administration, such as topical, intracameral, intravitreal, oral and parenteral. Among them the topical route is most accepted by patients, although it provides in many cases the lowest bioavailability. Indeed, when a topical formulation reaches the precorneal area, i.e., the drug absorption and/or action site, it is rapidly eliminated due to eye protection mechanisms such as blinking, basal and reflex tearing, and naso-lacrimal draining. To avoid this and to reduce the frequency of dosing, various strategies have been developed to prolong drug residence time after topical administration. These strategies include the use of viscosity increasing and mucoadhesive excipients as well as combinations thereof. From the drug delivery system point of view, liquid and semisolid formulations are preferred over solid formulations such as ocular inserts and contact lenses. Furthermore, liquid and semisolid formulations can contain nano- and microcarrier systems that contribute to a prolonged residence time. Within this review an overview about the different types of excipients and formulations as well as their performance in valid animal models and clinical trials is provided.
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Affiliation(s)
- Brunella Grassiri
- Department of Pharmacy, University of Pisa, Via Bonanno 33, 56126 Pisa, Italy
| | - Ylenia Zambito
- Department of Pharmacy, University of Pisa, Via Bonanno 33, 56126 Pisa, Italy; Department of Pharmacy, University of Pisa, Via Bonanno 33, 56126 Pisa, Italy; Interdepartmental Research Center "Nutraceuticals and Food for Health", University of Pisa, Pisa 56100, Italy
| | - Andreas Bernkop-Schnürch
- Institute of Pharmacy/Dep. of Pharmaceutical Technology, Center for Chemistry and Biomedicine, University of Innsbruck, Innrain 80/82, 6020 Innsbruck, Austria.
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Mazet R, García-Otero X, Choisnard L, Wouessidjewe D, Verdoot V, Bossard F, Díaz-Tomé V, Blanc-Marquis V, Otero-Espinar FJ, Fernandez-Ferreiro A, Gèze A. Biopharmaceutical Assessment of Dexamethasone Acetate-Based Hydrogels Combining Hydroxypropyl Cyclodextrins and Polysaccharides for Ocular Delivery. Pharmaceutics 2020; 12:pharmaceutics12080717. [PMID: 32751583 PMCID: PMC7464375 DOI: 10.3390/pharmaceutics12080717] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 12/25/2022] Open
Abstract
We previously developed two optimized formulations of dexamethasone acetate (DXMa) hydrogels by means of special cubic mixture designs for topical ocular administration. These gels were elaborated with hydroxypropyl-β-CD (HPβCD) and hydroxypropyl-γ-CD (HPγCD) and commercial hydrogels in order to enhance DXMa water solubility and finally DXMa's ocular bioavailability and transcorneal penetration. The main objective of this study was to characterize them and to evaluate in vitro, ex vivo, and in vivo their safety, biopermanence, and transcorneal permeation. Gels A and B are Newtonian fluids and display a viscosity of 13.2 mPa.s and 18.6 mPa.s, respectively, which increases their ocular retention, according to the in vivo biopermanence study by PET/CT. These hydrogels could act as corneal absorption promoters as they allow a higher transcorneal permeation of DXMa through porcine excised cornea, compared to DEXAFREE® and MAXIDEX®. Cytotoxicity assays showed no cytotoxic effects on human primary corneal epithelial cells (HCE). Furthermore, Gel B is clearly safe for the eye, but the effect of Gel A on the human eye cannot be predicted. Both gels were also stable 12 months at 25 °C after sterilization by filtration. These results demonstrate that the developed formulations present a high potential for the topical ocular administration of dexamethasone acetate.
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Affiliation(s)
- Roseline Mazet
- University Grenoble Alpes, CNRS, DPM, 38000 Grenoble, France; (R.M.); (L.C.); (D.W.); (V.B.-M.)
- Pharmacy Unit, Grenoble University Hospital, 38000 Grenoble, France
| | - Xurxo García-Otero
- Department of Pharmacology, Pharmacy, Pharmaceutical Technology and Industrial Pharmacy Institute, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain; (X.G.-O.); (V.D.-T.); (F.-J.O.-E.)
- Molecular Imaging Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Luc Choisnard
- University Grenoble Alpes, CNRS, DPM, 38000 Grenoble, France; (R.M.); (L.C.); (D.W.); (V.B.-M.)
| | - Denis Wouessidjewe
- University Grenoble Alpes, CNRS, DPM, 38000 Grenoble, France; (R.M.); (L.C.); (D.W.); (V.B.-M.)
| | - Vincent Verdoot
- University Grenoble Alpes, CNRS, Grenoble INP, LRP, 38000 Grenoble, France; (V.V.); (F.B.)
| | - Frédéric Bossard
- University Grenoble Alpes, CNRS, Grenoble INP, LRP, 38000 Grenoble, France; (V.V.); (F.B.)
| | - Victoria Díaz-Tomé
- Department of Pharmacology, Pharmacy, Pharmaceutical Technology and Industrial Pharmacy Institute, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain; (X.G.-O.); (V.D.-T.); (F.-J.O.-E.)
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Véronique Blanc-Marquis
- University Grenoble Alpes, CNRS, DPM, 38000 Grenoble, France; (R.M.); (L.C.); (D.W.); (V.B.-M.)
| | - Francisco-Javier Otero-Espinar
- Department of Pharmacology, Pharmacy, Pharmaceutical Technology and Industrial Pharmacy Institute, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain; (X.G.-O.); (V.D.-T.); (F.-J.O.-E.)
| | - Anxo Fernandez-Ferreiro
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
- Pharmacy Department, Clinical University Hospital Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Correspondence: (A.F.-F.); (A.G.); Tel.: +33-476-63-53-01 (A.G.)
| | - Annabelle Gèze
- University Grenoble Alpes, CNRS, DPM, 38000 Grenoble, France; (R.M.); (L.C.); (D.W.); (V.B.-M.)
- Correspondence: (A.F.-F.); (A.G.); Tel.: +33-476-63-53-01 (A.G.)
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Trehalose for Ocular Surface Health. Biomolecules 2020; 10:biom10050809. [PMID: 32466265 PMCID: PMC7277924 DOI: 10.3390/biom10050809] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/14/2020] [Accepted: 05/21/2020] [Indexed: 12/14/2022] Open
Abstract
Trehalose is a natural disaccharide synthesized in various life forms, but not found in vertebrates. An increasing body of evidence demonstrates exceptional bioprotective characteristics of trehalose. This review discusses the scientific findings on potential functions of trehalose in oxidative stress, protein clearance, and inflammation, with an emphasis on animal models and clinical trials in ophthalmology. The main objective is to help understand the beneficial effects of trehalose in clinical trials and practice, especially in patients suffering from ocular surface disease. The discussion is supplemented with an overview of patents for the use of trehalose in dry eye and with prospects for the 2020s.
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Dubashynskaya N, Poshina D, Raik S, Urtti A, Skorik YA. Polysaccharides in Ocular Drug Delivery. Pharmaceutics 2019; 12:E22. [PMID: 31878298 PMCID: PMC7023054 DOI: 10.3390/pharmaceutics12010022] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/19/2019] [Accepted: 12/22/2019] [Indexed: 02/07/2023] Open
Abstract
Polysaccharides, such as cellulose, hyaluronic acid, alginic acid, and chitosan, as well as polysaccharide derivatives, have been successfully used to augment drug delivery in the treatment of ocular pathologies. The properties of polysaccharides can be extensively modified to optimize ocular drug formulations and to obtain biocompatible and biodegradable drugs with improved bioavailability and tailored pharmacological effects. This review discusses the available polysaccharide choices for overcoming the difficulties associated with ocular drug delivery, and it explores the reasons for the dependence between the physicochemical properties of polysaccharide-based drug carriers and their efficiency in different formulations and applications. Polysaccharides will continue to be of great interest to researchers endeavoring to develop ophthalmic drugs with improved effectiveness and safety.
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Affiliation(s)
- Natallia Dubashynskaya
- Institute of Macromolecular Compounds of the Russian Academy of Sciences, Bolshoy pr. V.O. 31, 199004 St. Petersburg, Russia; (N.D.); (D.P.); (S.R.)
| | - Daria Poshina
- Institute of Macromolecular Compounds of the Russian Academy of Sciences, Bolshoy pr. V.O. 31, 199004 St. Petersburg, Russia; (N.D.); (D.P.); (S.R.)
| | - Sergei Raik
- Institute of Macromolecular Compounds of the Russian Academy of Sciences, Bolshoy pr. V.O. 31, 199004 St. Petersburg, Russia; (N.D.); (D.P.); (S.R.)
- Institute of Chemistry, St. Petersburg State University, Universitetskii pr. 26, Petrodvorets, 198504 St. Petersburg, Russia;
| | - Arto Urtti
- Institute of Chemistry, St. Petersburg State University, Universitetskii pr. 26, Petrodvorets, 198504 St. Petersburg, Russia;
- Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, P.O. Box 56, FI-00014 Helsinki, Finland
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, 70210 Kuopio, Finland
| | - Yury A. Skorik
- Institute of Macromolecular Compounds of the Russian Academy of Sciences, Bolshoy pr. V.O. 31, 199004 St. Petersburg, Russia; (N.D.); (D.P.); (S.R.)
- Institute of Chemistry, St. Petersburg State University, Universitetskii pr. 26, Petrodvorets, 198504 St. Petersburg, Russia;
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Comparison study of two different topical lubricants on tear meniscus and tear osmolarity in dry eye. Cont Lens Anterior Eye 2019; 43:373-377. [PMID: 31615726 DOI: 10.1016/j.clae.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare the effect of single-drop administration of two different ophthalmic solutions on tear meniscus and tear osmolarity in patients with mild to moderate dry eye disease. METHODS This prospective study comprised of 122 patients with mild to moderate dry eye disease. These patients received a single dose of either unpreserved trehalose 3%, hyaluronic acid 0.15%, carbomer 0.25% (THHA, Thealoz Duo Gel) (Group 1) or hyaluronic acid 0.3% (HA) (Group 2) gel-based lubricants. Tear meniscus (height and depth) were measured using anterior segment optic coherence tomography (AS-OCT) at baseline and 10, 60, 120, and 240 min. after instillation. Tear osmolarity, Schirmer I test, tear break-up time (TBUT), gel properties, and patient comfort were evaluated 240 min. after instillation. RESULTS Tear meniscus height (TMH) and tear meniscus depth (TMD) showed a significant increase with both lubricants compared to the baseline (p < 0.001). This effect remained significant for up to 60 min. and 120 min. for the THHA and HA 0.3% solutions, respectively (p < 0.05, for both). Mean comfort duration was 115.1 ± 20.1 min. in Group 1 and 148.3 ± 49.0 min in Group 2 (p < 0.001). Tear osmolarity, Schirmer I test, and TBUT were similar between the baseline and 240 min. for each group. CONCLUSIONS The results of this study demonstrate that 0.3% HA remains on the ocular surface for longer than TH-HA. The longer ocular residency time also seems to correlate with a longer patient comfort duration.
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Mun J, Mok JW, Jeong S, Cho S, Joo CK, Hahn SK. Drug-eluting contact lens containing cyclosporine-loaded cholesterol-hyaluronate micelles for dry eye syndrome. RSC Adv 2019; 9:16578-16585. [PMID: 35516366 PMCID: PMC9064448 DOI: 10.1039/c9ra02858g] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/13/2019] [Indexed: 12/13/2022] Open
Abstract
A cholesterol-hyaluronate (C-HA) micelle embedded contact lens was developed for efficient hydrophobic drug loading and long-term controlled drug delivery.
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Affiliation(s)
- Jonghwan Mun
- Department of Materials Science and Engineering
- Pohang University of Science and Technology (POSTECH)
- Pohang
- Korea
| | - Jee won Mok
- Department of Ophthalmology and Visual Science
- Seoul St. Mary's Hospital
- Collage of Medicine
- The Catholic University of Korea
- Seocho-gu
| | - Sanghoon Jeong
- Department of Materials Science and Engineering
- Pohang University of Science and Technology (POSTECH)
- Pohang
- Korea
| | - Seonghwi Cho
- Department of Materials Science and Engineering
- Pohang University of Science and Technology (POSTECH)
- Pohang
- Korea
| | - Choun-Ki Joo
- Department of Ophthalmology and Visual Science
- Seoul St. Mary's Hospital
- Collage of Medicine
- The Catholic University of Korea
- Seocho-gu
| | - Sei Kwang Hahn
- Department of Materials Science and Engineering
- Pohang University of Science and Technology (POSTECH)
- Pohang
- Korea
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Shen Y, Yu Y, Chaurasiya B, Li X, Xu Y, Webster TJ, Tu J, Sun R. Stability, safety, and transcorneal mechanistic studies of ophthalmic lyophilized cyclosporine-loaded polymeric micelles. Int J Nanomedicine 2018; 13:8281-8296. [PMID: 30584300 PMCID: PMC6287540 DOI: 10.2147/ijn.s173691] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction Cyclosporine-A (CsA) is generally used as an immunosuppressant and is also prescribed for some ophthalmic applications such as vernal keratoconjunctivitis and dry eye. However, it is limited clinically due to its low aqueous solubility and ocular bioavailability. Methods In this work, lyophilized methoxy poly(ethylene glycol)-poly(lactide) (mPEG-PLA) polymer micelles were prepared for ophthalmic formulations as a promising nanocarrier for hydrophobic drugs like CsA. A mPEG-PLA diblock polymer was synthesized by ring opening polymerization and CsA was loaded into mPEG-PLA micelles by a simple film dispersion method. A uniform design of experiments was utilized to optimize the final formulation. The obtained formulation was characterized for diameter (57.0±3.2 nm), entrapment efficiency % (98.51±1.4), and in vitro release. Moreover, incorporating the stabilizer mPEG2000 could increase the in vitro stability of the lyophilized CsA-loaded mPEG-PLA micelles. Results Results showed a sustained release of CsA from the micelles. Drug concentration and time-dependent cytotoxicity of human corneal epithelial-2 cells was observed. Additionally, the transcorneal mechanism of mPEG-PLA micelles was studied and the results showed that the mPEG-PLA micelles mainly absorbed by a paracellular pathway via corneal epithelial cells. Conclusion Taken together, the results proved that this mPEG-PLA diblock polymer can be potentially used as a nanoscopic carrier to deliver hydrophobic drugs in a controlled manner to the ocular region and, thus, deserves further attention.
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Affiliation(s)
- Yan Shen
- Department of Pharmaceutics, Center for Research Development and Evaluation of Pharmaceutical Excipients and Generic Drugs, School of Pharmacy, China Pharmaceutical University, Nanjing, China,
| | - Yinglan Yu
- Department of Pharmaceutics, Center for Research Development and Evaluation of Pharmaceutical Excipients and Generic Drugs, School of Pharmacy, China Pharmaceutical University, Nanjing, China,
| | - Birendra Chaurasiya
- Department of Pharmaceutics, Center for Research Development and Evaluation of Pharmaceutical Excipients and Generic Drugs, School of Pharmacy, China Pharmaceutical University, Nanjing, China,
| | - Xiaolian Li
- Department of Pharmaceutics, Center for Research Development and Evaluation of Pharmaceutical Excipients and Generic Drugs, School of Pharmacy, China Pharmaceutical University, Nanjing, China,
| | - Ying Xu
- College of Pharmacy, Jiangsu University, Zhenjiang, China
| | - Thomas J Webster
- Department of Chemical Engineering, Northeastern University, Boston, MA, USA
| | - Jiasheng Tu
- Department of Pharmaceutics, Center for Research Development and Evaluation of Pharmaceutical Excipients and Generic Drugs, School of Pharmacy, China Pharmaceutical University, Nanjing, China,
| | - Runing Sun
- School of Engineering, China Pharmaceutical University, Nanjing, China,
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La Gatta A, Corsuto L, Salzillo R, D'Agostino A, De Rosa M, Bracco A, Schiraldi C. In Vitro Evaluation of Hybrid Cooperative Complexes of Hyaluronic Acid as a Potential New Ophthalmic Treatment. J Ocul Pharmacol Ther 2018; 34:677-684. [PMID: 30325680 DOI: 10.1089/jop.2018.0046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE The purpose of this in vitro study was to assess the potential benefits of eye drops based on hybrid cooperative complexes (HCCs) obtained from high and low molecular weight hyaluronic acid (HA). METHODS Rheological measurements were performed to adjust the HCC concentration toward optimal resistance to drainage from the ocular surface. The viscosity and mucoadhesion profiles of the optimized preparation were derived. Primary porcine corneal epithelial cells were used for biological studies. Cells were exposed to dehydration after being pretreated with the HCC solution, and protection from desiccation was evaluated using cell viability assays. Time-lapse experiments were carried out to evaluate the ability of the HCC preparation to promote corneal wound healing. The characterization studies were performed in comparison with a control HA solution representative of commercial HA-based products. RESULTS The HCC formulation is able to deliver twice the amount of biopolymer compared with conventional products while avoiding discomfort due to excessive viscosity. The viscosity and mucoadhesion profiles allowed the authors to predict the longer in vivo retention and, therefore, an improved HCC formulation bioavailability. The new preparation also proved superior in protecting porcine corneal epithelial cells from desiccation and in hastening corneal cell wound repair in vitro. CONCLUSIONS The results suggest that the developed formulation may be a promising topical ophthalmic medical treatment.
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Affiliation(s)
- Annalisa La Gatta
- 1 Department of Experimental Medicine, School of Medicine, University of Campania "Luigi Vanvitelli ," Naples, Italy
| | - Luisana Corsuto
- 1 Department of Experimental Medicine, School of Medicine, University of Campania "Luigi Vanvitelli ," Naples, Italy
| | - Rosanna Salzillo
- 1 Department of Experimental Medicine, School of Medicine, University of Campania "Luigi Vanvitelli ," Naples, Italy
| | - Antonella D'Agostino
- 1 Department of Experimental Medicine, School of Medicine, University of Campania "Luigi Vanvitelli ," Naples, Italy
| | - Mario De Rosa
- 1 Department of Experimental Medicine, School of Medicine, University of Campania "Luigi Vanvitelli ," Naples, Italy
| | - Adele Bracco
- 2 Center of Biotechnologies , Antonio Cardarelli Hospital, Naples, Italy
| | - Chiara Schiraldi
- 1 Department of Experimental Medicine, School of Medicine, University of Campania "Luigi Vanvitelli ," Naples, Italy
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Szegedi S, Scheschy U, Schmidl D, Aranha Dos Santos V, Stegmann H, Adzhemian N, Fondi K, Bata AM, Werkmeister RM, Couderc C, Schmetterer L, Garhofer G. Effect of Single Instillation of Two Hyaluronic Acid-Based Topical Lubricants on Tear Film Thickness in Patients with Dry Eye Syndrome. J Ocul Pharmacol Ther 2018; 34:605-611. [PMID: 30325687 DOI: 10.1089/jop.2018.0069] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE This study investigated the effect of single administration of 2 different hyaluronic acid-based topical lubricants on tear film thickness (TFT) in patients with moderate-to-severe dry eye disease (DED). METHODS Sixty patients were randomized to receive eye drops containing unpreserved sodium hyaluronate, triglycerides, and phospholipids (HTP), unpreserved sodium hyaluronate (HA), or unpreserved sodium chloride (NaCl). TFT and lipid layer thickness (LLT) were assessed before and at defined time points after single instillation with a custom-built ultrahigh-resolution optical coherence tomography system and a white light interferometer. Standard tests for DED such as a visual analogue scale (VAS), corneal fluorescein staining (CFS), Schirmer I test, and tear break-up time (BUT) were performed. RESULTS The time course in TFT was significantly different between the 3 administered agents (P < 0.001). Single administration of HTP significantly increased TFT over a period of 40 min, an increase in TFT over 20 min was observed after instillation of HA, whereas NaCl had no effect. No significant difference in the change in BUT, CFS, or LLT was observed between the 3 groups (P = 0.57, 0.97, and 0.86, respectively). A significant improvement in subjective symptoms (VAS) was found after single instillation of HTP (P = 0.03 vs. baseline) and HA, but not after administration of NaCl (P = 0.03, P < 0.01, and P = 0.08 vs. baseline, respectively, P = 0.57 between groups). CONCLUSIONS Single administration of HTP and HA significantly increased TFT showing a longer residence time and improved subjective symptoms, whereas instillation of NaCl had no effect. Long-term studies with multiple instillations will be necessary to further investigate the effect of the tested products on the clinical outcome. ClinicalTrials.gov ID: NCT03161080.
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Affiliation(s)
- Stephan Szegedi
- 1 Department of Clinical Pharmacology, Medical University of Vienna , Vienna, Austria
| | - Ulrike Scheschy
- 1 Department of Clinical Pharmacology, Medical University of Vienna , Vienna, Austria
| | - Doreen Schmidl
- 1 Department of Clinical Pharmacology, Medical University of Vienna , Vienna, Austria
| | | | - Hannes Stegmann
- 2 Center for Medical Physics and Biomedical Engineering, Medical University of Vienna , Vienna, Austria .,3 Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Medical University of Vienna , Vienna, Austria
| | - Narine Adzhemian
- 1 Department of Clinical Pharmacology, Medical University of Vienna , Vienna, Austria .,4 Helmholtz Research Institute of Eye Diseases, Moscow, Russia
| | - Klemens Fondi
- 1 Department of Clinical Pharmacology, Medical University of Vienna , Vienna, Austria
| | - Ahmed M Bata
- 1 Department of Clinical Pharmacology, Medical University of Vienna , Vienna, Austria
| | - René M Werkmeister
- 2 Center for Medical Physics and Biomedical Engineering, Medical University of Vienna , Vienna, Austria .,3 Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Medical University of Vienna , Vienna, Austria
| | | | - Leopold Schmetterer
- 1 Department of Clinical Pharmacology, Medical University of Vienna , Vienna, Austria .,2 Center for Medical Physics and Biomedical Engineering, Medical University of Vienna , Vienna, Austria .,6 Singapore Eye Research Institute , The Academia, Singapore, Singapore .,7 Lee Kong Chian School of Medicine, Nanyang Technological University , Singapore, Singapore .,8 Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School , Singapore, Singapore
| | - Gerhard Garhofer
- 1 Department of Clinical Pharmacology, Medical University of Vienna , Vienna, Austria
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Hialid®/Hyalein® (sodium hyaluronate) ophthalmic solution in dry eye syndrome: a profile of its use. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0540-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bock U, Deylen D V, M J, M D, C S, S R. Development of In Vitro Methodologies to Investigate Binding by Sodium Hyaluronate in Eye Drops to Corneal Surfaces. Open Ophthalmol J 2018; 12:226-240. [PMID: 30159097 PMCID: PMC6080064 DOI: 10.2174/1874364101812010226] [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: 03/07/2018] [Revised: 06/05/2018] [Accepted: 07/12/2018] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To develop in vitro methods to assess binding by sodium hyaluronate in eye drops to corneal surfaces. METHODS Two different, complementary corneal binding set-ups were developed. In a dynamic in vitro model, confluent corneal epithelial cells (HCE-T) were assembled in chamber slides and a declining channel. A static model was constructed with ex vivo porcine corneas clamped in Franz cells. To test the predictive capacity of models, four different eye drops containing sodium hyaluronate were spiked with tritium-labeled sodium hyaluronate to standardize quantification. In both settings, eye drops were applied for 5 min and physiological conditions were mimicked by flushing with artificial tear fluid. Spreading experiments on HCE-T next to synthetic membranes were used for further characterization. RESULTS Binding was more pronounced in dynamic HCE-T model. Three of the four eye drops demonstrated sigmoidal elution of sodium hyaluronate, suggesting pronounced binding. One solution eluted distinctly faster, likewise the buffer control. The static method produced a similar ranking but at lower levels. When eye drops in which phosphate buffer was replaced by citrate buffer (i.e., to prevent calcification) were used, binding was not influenced. All eye drops spread immediately when placed on HCE-T and at the same order of magnitude on glass and polyethylene terephthalate surfaces. CONCLUSION Dynamic and static models performed on different corneal sources were used to determine sodium hyaluronate binding kinetics in solutions under physiological conditions. These methodologies resulted in a ranking of the capacity of sodium hyaluronate to bind in vitro to corneal surfaces.
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Affiliation(s)
- Udo Bock
- Bock Project Management, Tawern, Germany
| | - Von Deylen D
- Technische Universität Carolo-Wilhelmina zu Braunschweig, Institut für Pharmazeutische Technologie, Braunschweig, Germany
| | - Jochner M
- Technische Universität Carolo-Wilhelmina zu Braunschweig, Institut für Pharmazeutische Technologie, Braunschweig, Germany
| | - Doerr M
- Bayer Vital GmbH, Scientific Affairs Consumer Health, Leverkusen, Germany
| | - Stäbler C
- Bayer Vital GmbH, Scientific Affairs Consumer Health, Leverkusen, Germany
| | - Reichl S
- Technische Universität Carolo-Wilhelmina zu Braunschweig, Institut für Pharmazeutische Technologie, Braunschweig, Germany
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Lee JS, Park JM, Cho HK, Kim SJ, Huh HD, Park YM. Influence of Sodium Hyaluronate Concentration on Corneal Aberrations in Soft Contact Lens Wearers. KOREAN JOURNAL OF OPHTHALMOLOGY 2018; 32:89-94. [PMID: 29611370 PMCID: PMC5906407 DOI: 10.3341/kjo.2017.0099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/29/2017] [Indexed: 12/11/2022] Open
Abstract
Purpose This study aimed to evaluate the influence of varying concentrations of sodium hyaluronate (SH) eye drops on corneal aberrations in normal individuals wearing silicone hydrogel contact lenses. Methods Normal individuals wearing silicone hydrogel contact lenses were enrolled in this study. Subjects were classified into two groups depending on the concentration of the preservative-free SH used (group 1, 0.1% SH; group 2, 0.3% SH). All subjects were asked to blink five times after instillation of the SH eye drop and before the Galilei measurements. Corneal aberrations were measured over the contact lenses before and after SH eye drop instillation. Visual acuity (VA) over the contact lenses was also measured both before instillation of the SH eye drop and after the subjects completed the five blinks. Results There was no change in VA after SH instillation in group 1; however, group 2's VA significantly deteriorated after SH instillation. Changes in VA after SH instillation compared to baseline were significantly higher in group 2 than in group 1. Similarly, the increase in corneal aberrations after SH instillation was significant in group 2 but not significant in group 1. Among the significantly increased corneal aberration parameters, defocus was the main type in group 2. Changes in corneal aberrations after SH instillation compared to baseline were significantly higher in group 2 than in group 1. Conclusions A 0.3%-concentration of SH increases corneal aberration and decreases VA in soft contact lens wearers. Defocus is the main type of aberration that increased in the 0.3% SH instillation group.
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Affiliation(s)
- Jong Soo Lee
- Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Yangsan, Korea
| | - Jong Moon Park
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Hyun Kyung Cho
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Su Jin Kim
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Hyoun Do Huh
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Young Min Park
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea.
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Kapoor Y, Dixon P, Sekar P, Chauhan A. Incorporation of drug particles for extended release of Cyclosporine A from poly-hydroxyethyl methacrylate hydrogels. Eur J Pharm Biopharm 2017; 120:73-79. [DOI: 10.1016/j.ejpb.2017.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/06/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
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Simmons PA, Vehige JG. Investigating the potential benefits of a new artificial tear formulation combining two polymers. Clin Ophthalmol 2017; 11:1637-1642. [PMID: 28979093 PMCID: PMC5602465 DOI: 10.2147/opth.s135550] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Artificial tear formulations typically contain a water-soluble polymer to enhance residence time, moisture retention, and binding to the mucin coat of the ocular surface, which facilitate corneal healing. This study investigated the potential advantages of combining carboxymethylcellulose (CMC) and hyaluronic acid (HA) polymers in a single formulation. MATERIALS AND METHODS Individual CMC and HA solutions were prepared and tested for bulk viscosity in comparison to a solution that combined CMC and HA. Rheometry determined the differences between solutions at increasing shear rates, simulating eye movement and blinking. RESULTS The bulk viscosity of the individual 0.5% CMC and 0.1% HA solutions was 2.5 and 5.7 cP, respectively. The viscosity of the combined solution (13.1 cP) was 60% higher than predicted by additive effects. Rheometry revealed shear rates between 10/second (open eye) and 10,000/second (blinking eye). At these rates, viscosity ranged from 2.7 to 3.5 cP for 0.5% CMC, 2.8 to 6.8 cP for 0.1% HA, and 5.2 to 15.3 cP for the 0.5% CMC-0.1% HA combination. Low-shear viscosity of the CMC-HA combination increased 48% over the sum of the individual solutions, but high-shear viscosity remained virtually unchanged. Data from CMC and HA solutions at higher concentrations were consistent with these results. CONCLUSION Combining CMC and HA polymers produced a synergistic increase in low-shear viscosity (which cannot be fully explained by simple molecular entanglement), while the high-shear viscoelasticity of the combined solution remained unaffected. These data suggest that CMC-HA combinations have properties that may be used to formulate artificial tears that optimize ocular retention (through higher low-shear viscosity), while minimizing blur and stickiness during blinking (through lower high-shear viscosity).
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Perényi K, Dienes L, Kornafeld A, Kovács B, Kiss HJ, Szepessy Z, Nagy ZZ, Barsi Á, Acosta MC, Gallar J, Kovács I. The Effect of Tear Supplementation with 0.15% Preservative-Free Zinc-Hyaluronate on Ocular Surface Sensations in Patients with Dry Eye. J Ocul Pharmacol Ther 2017; 33:487-492. [DOI: 10.1089/jop.2016.0194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kristóf Perényi
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Lóránt Dienes
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Anna Kornafeld
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Balázs Kovács
- Department of Ophthalmology, Kaposi Mor Hospital, Kaposvár, Hungary
| | - Huba J. Kiss
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | | | - Zoltán Z. Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Árpád Barsi
- Department of Photogrammetry and Geoinformatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - M. Carmen Acosta
- Instituto de Neurociencias, Universidad Miguel Hernandez-CSIC, San Juan de Alicante, Spain
| | - Juana Gallar
- Instituto de Neurociencias, Universidad Miguel Hernandez-CSIC, San Juan de Alicante, Spain
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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Wozniak PA, Schmidl D, Bata AM, Fondi K, Witkowska KJ, Aranha dos Santos V, Baar C, Room KI, Nepp J, Baumgartner I, Popa-Cherecheanu A, Garhöfer G, Werkmeister RM, Schmetterer L. Effect of different lubricant eye gels on tear film thickness as measured with ultrahigh-resolution optical coherence tomography. Acta Ophthalmol 2017; 95:e307-e313. [PMID: 27989018 DOI: 10.1111/aos.13342] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/20/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE To compare the effect of a single drop of different lubricant eye gels on tear film thickness (TFT) as measured with ultrahigh-resolution optical coherence tomography (UHR-OCT) in patients with mild-to-moderate dry eye disease (DED). METHODS The study followed a randomized, single-masked, observer-blinded parallel group design. Patients received a single dose of either unpreserved trehalose 3% + hyaluronic acid 0.15% (TH), hyaluronic acid 0.2% (HA) or polyethylene glycol 0.4% + propylene glycol 0.3% (PP) eye drops. In total, 60 patients were included and TFT was measured using a custom-built UHR-OCT system. RESULTS The mean TFT at baseline was 3.5 ± 0.7 μm. There was a significant difference in the time-course of TFT between the three groups (p = 0.001 between groups). Ten minutes after instillation, TFT increased by 155.8 ± 86.6%, 65.7 ± 71.5% and 33.4 ± 19.6% in the PP, TH and HA group, respectively (p < 0.001 between groups). Thirty minutes after instillation, the effect of all three different agents on TFT was comparable. Sixty and 120 min after administration, a significant increase in TFT was only seen for the TH group, but not for the other products (60 min: p < 0.021 between groups; 120 min: p < 0.037 between groups). CONCLUSION In conclusion, we observed differences in TFT after administration of the lubricant gels. Ten minutes after instillation, a pronounced increase in TFT was observed in all groups. As compared to the other products, the combination of trehalose 3% + hyaluronic acid 0.15% offers a significantly longer increase in TFT indicating for a longer residence time.
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Affiliation(s)
- Piotr A. Wozniak
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
- Department of Ophthalmology; Medical University of Warsaw; Warsaw Poland
| | - Doreen Schmidl
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
- Center for Medical Physics and Biomedical Engineering; Medical University of Vienna; Vienna Austria
| | - Ahmed M. Bata
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - Klemens Fondi
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | | | | | - Carina Baar
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - Kim I. Room
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - Johannes Nepp
- Department of Ophthalmology; Medical University Vienna; Vienna Austria
| | | | - Alina Popa-Cherecheanu
- Department of Ophthalmology; Emergency University Hospital; Carol Davila University of Medicine and Pharmacy; Bucharest Romania
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - René M. Werkmeister
- Center for Medical Physics and Biomedical Engineering; Medical University of Vienna; Vienna Austria
| | - Leopold Schmetterer
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
- Center for Medical Physics and Biomedical Engineering; Medical University of Vienna; Vienna Austria
- Singapore Eye Research Institute; Singapore Singapore
- Lee Kong Chian School of Medicine; Nanyang Technological University; Singapore Singapore
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Fernández-Ferreiro A, Silva-Rodríguez J, Otero-Espinar FJ, González-Barcia M, Lamas MJ, Ruibal A, Luaces-Rodríguez A, Vieites-Prado A, Lema I, Herranz M, Gómez-Lado N, Blanco-Mendez J, Gil-Martínez M, Pardo M, Moscoso A, Cortes J, Sánchez-Martínez M, Pardo-Montero J, Aguiar P. In vivo eye surface residence determination by high-resolution scintigraphy of a novel ion-sensitive hydrogel based on gellan gum and kappa-carrageenan. Eur J Pharm Biopharm 2017; 114:317-323. [DOI: 10.1016/j.ejpb.2017.01.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/12/2017] [Accepted: 01/17/2017] [Indexed: 02/02/2023]
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Rolando M, Vagge A. Safety and Efficacy of Cortisol Phosphate in Hyaluronic Acid Vehicle in the Treatment of Dry Eye in Sjogren Syndrome. J Ocul Pharmacol Ther 2017; 33:383-390. [PMID: 28375792 DOI: 10.1089/jop.2016.0147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Evaluation of 0.3% cortisol phosphate eye drops in hyaluronic acid vehicle in the treatment of dry eye in Sjogren Syndrome. METHODS This prospective, single-center, masked (single blind), randomized controlled study included 40 female patients divided into 2 groups, group 1 treated with Idracemi, 0.3% cortisol phosphate eye drops twice a day, and group 2 treated with Cortivis, 0.3% cortisol phosphate in hyaluronic acid vehicle, with the same posology. Screening (day -7), randomization (day 0), follow-up (day 7), and termination (day 28) visits were conducted. Symptoms (VAS) questionnaire, tear film breakup time, corneo-conjunctival stain, intraocular pressure (IOP) measurement, and fundus examination were performed at each visit. Conjunctival impression cytology for human leukocyte antigen-DR (HLA-DR) expression at visit 1 and 4 was also performed. RESULTS No changes in IOP or fundus examination were observed in either group at each time point. Group 1 showed at day 28 a statistically significant amelioration of symptoms and reduction of HLA-DR expression. Group 2 showed at day 7 statistically significant improvement of corneal and conjunctival stain versus baseline and versus group 1; the symptom score was statistically significantly better than baseline and versus group 1 after 28 days too. The HLA-DR expression and the epithelial cell area were statistically significantly reduced versus baseline and versus group 1 at the same time. CONCLUSIONS Cortisol phosphate proved to be safe and effective in treating dry eye in Sjogren Syndrome patients in both formulations. However, the formula with hyaluronic acid vehicle proved to be more effective. Both formulations were very well tolerated.
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Affiliation(s)
- Maurizio Rolando
- 1 ISPRE Oftalmica , Genova, Italy .,2 Dipartimento di Scienze Neurologiche, Oftalmologia, Genetica e Scienze Materno Infantili, Università di Genova , Genova, Italy
| | - Aldo Vagge
- 2 Dipartimento di Scienze Neurologiche, Oftalmologia, Genetica e Scienze Materno Infantili, Università di Genova , Genova, Italy
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Scheuer CA, Rah MJ, Reindel WT. Increased concentration of hyaluronan in tears after soaking contact lenses in Biotrue multipurpose solution. Clin Ophthalmol 2016; 10:1945-1952. [PMID: 27784983 PMCID: PMC5063495 DOI: 10.2147/opth.s115705] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose This study was conducted to determine 1) the concentration of hyaluronan (HA) in the tear films of contact lens (CL) wearers versus non-CL wearers and 2) whether HA sorbed from Biotrue, an HA-containing multipurpose solution (MPS), onto senofilcon A lenses affects the concentration of HA in tears after 2 hours of wear. Patients and methods Tears of habitual CL wearers and non-CL wearers were collected on Schirmer strips at baseline and after 2 hours of wear of senofilcon A CLs that had first been either rinsed with Sensitive Eyes Saline or soaked in Biotrue MPS for 14 hours. HA concentrations were measured by enzyme-linked immunosorbent assay (ELISA) and adjusted for sample volumes. Results No difference in baseline concentrations of HA in tears was found between CL wearers and non-CL wearers (P=0.07), nor between males and females (P=0.06). However, age was significantly negatively associated with HA concentration (P<0.01), and mostly, CL wear contributed to a significant association (P<0.01). Among saline-rinsed CL wearers, no change in HA concentration in tears was observed after 2 hours of wear (P=0.38). By contrast, a significant increase in HA concentration was observed in the tears from eyes that had worn CLs soaked in Biotrue MPS when compared to baseline (P=0.01) or to saline-rinsed control (P=0.03). Conclusion 1) In this study population, no difference in baseline concentration of HA was observed between CL wearers and non-CL wearers, and 2) after 2 hours of wear of senofilcon A lenses that were soaked in Biotrue MPS, HA concentrations in the tear films of CL wearers increased.
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Affiliation(s)
| | - Marjorie J Rah
- Vision Care, Bausch & Lomb Incorporated, Rochester, NY, USA
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Song S, Zhao D, Sun J, Miao Q, Liu X, Wang Y, Zhong L, Xu M, Zhang P. Development of a UPLC-MS/MS method for the determination of lomefloxacin in rabbit aqueous humor and its application to a pharmacokinetic study. J Chromatogr B Analyt Technol Biomed Life Sci 2016; 1033-1034:187-192. [PMID: 27565567 DOI: 10.1016/j.jchromb.2016.08.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/05/2016] [Accepted: 08/14/2016] [Indexed: 10/21/2022]
Abstract
Lomefloxacin is a kind of synthetic fluoroquinolone antibiotic, which is used for the treatment of infectious diseases. In this study, a rapid and efficient liquid chromatography-tandem mass spectrometric assay was developed to determine the concentration of lomefloxacin in rabbit aqueous humor quantitatively. Aqueous humor samples were extracted by protein precipitation. Ofloxacin was chosen as internal standard. The chromatographic separation was achieved on a Kinetex C18 (50mm×2.10mm, 2.6μm, Phenomenex Corp, USA) column, with a gradient of methanol (0.1% formic acid) and water (0.1% formic acid). Multiple reaction monitoring (MRM) with positive ionization mode was used for the mass analysis. The validation of this method was based on the European Medicines Agency (2011) [1] and US FDA Guidelines (2001) [2]. The calibration range of aqueous humor samples was 5-1200ng/mL with r=0.9990 (n=6). For all QC samples, Inter-and intra-run precisions were less than 15% and accuracies were between 80%-120%. In conclusion, the assay was rapid, sensitive and able to determinate the lomefloxacin in rabbit aqueous humor accurately. At the same time, this method was successfully applied to study the pharmacokinetics of lomefloxacin hydrochloride eye drops and lomefloxacin hydrochloride ophthalmic gel in rabbit aqueous humor.
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Affiliation(s)
- Shiwen Song
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Dongyang Zhao
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Jing Sun
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Qiuyan Miao
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Xiaojie Liu
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Yanling Wang
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Lu Zhong
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Meng Xu
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Peng Zhang
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China.
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Salzillo R, Schiraldi C, Corsuto L, D'Agostino A, Filosa R, De Rosa M, La Gatta A. Optimization of hyaluronan-based eye drop formulations. Carbohydr Polym 2016; 153:275-283. [PMID: 27561497 DOI: 10.1016/j.carbpol.2016.07.106] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/22/2016] [Accepted: 07/25/2016] [Indexed: 11/27/2022]
Abstract
Hyaluronan (HA) is frequently incorporated in eye drops to extend the pre-corneal residence time, due to its viscosifying and mucoadhesive properties. Hydrodynamic and rheological evaluations of commercial products are first accomplished revealing molecular weights varying from about 360 to about 1200kDa and viscosity values in the range 3.7-24.2mPa s. The latter suggest that most products could be optimized towards resistance to drainage from the ocular surface. Then, a study aiming to maximize the viscosity and mucoadhesiveness of HA-based preparations is performed. The effect of polymer chain length and concentration is investigated. For the whole range of molecular weights encountered in commercial products, the concentration maximizing performance is identified. Such concentration varies from 0.3 (wt%) for a 1100kDa HA up to 1.0 (wt%) for a 250kDa HA, which is 3-fold higher than the highest concentration on the market. The viscosity and mucoadhesion profiles of optimized formulations are superior than commercial products, especially under conditions simulating in vivo blinking. Thus longer retention on the corneal epithelium can be predicted. An enhanced capacity to protect corneal porcine epithelial cells from dehydration is also demonstrated in vitro. Overall, the results predict formulations with improved efficacy.
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Affiliation(s)
- Rosanna Salzillo
- Department of Experimental Medicine, Section of Biotechnology, Medical Histology and Molecular Biology, Bioteknet Second University of Naples, Via L. De Crecchio 7, 80138 Naples, Italy
| | - Chiara Schiraldi
- Department of Experimental Medicine, Section of Biotechnology, Medical Histology and Molecular Biology, Bioteknet Second University of Naples, Via L. De Crecchio 7, 80138 Naples, Italy.
| | - Luisana Corsuto
- Department of Experimental Medicine, Section of Biotechnology, Medical Histology and Molecular Biology, Bioteknet Second University of Naples, Via L. De Crecchio 7, 80138 Naples, Italy
| | - Antonella D'Agostino
- Department of Experimental Medicine, Section of Biotechnology, Medical Histology and Molecular Biology, Bioteknet Second University of Naples, Via L. De Crecchio 7, 80138 Naples, Italy
| | - Rosanna Filosa
- Department of Experimental Medicine, Section of Biotechnology, Medical Histology and Molecular Biology, Bioteknet Second University of Naples, Via L. De Crecchio 7, 80138 Naples, Italy
| | - Mario De Rosa
- Department of Experimental Medicine, Section of Biotechnology, Medical Histology and Molecular Biology, Bioteknet Second University of Naples, Via L. De Crecchio 7, 80138 Naples, Italy
| | - Annalisa La Gatta
- Department of Experimental Medicine, Section of Biotechnology, Medical Histology and Molecular Biology, Bioteknet Second University of Naples, Via L. De Crecchio 7, 80138 Naples, Italy.
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Gause S, Hsu KH, Shafor C, Dixon P, Powell KC, Chauhan A. Mechanistic modeling of ophthalmic drug delivery to the anterior chamber by eye drops and contact lenses. Adv Colloid Interface Sci 2016; 233:139-154. [PMID: 26318359 DOI: 10.1016/j.cis.2015.08.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 08/05/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
Ophthalmic drug for the anterior chamber diseases are delivered into tears by either eye drops or by extended release devices placed in the eyes. The instilled drug exits the eye through various routes including tear drainage into the nose through the canaliculi and transport across various ocular membranes. Understanding the mechanisms relevant to each route can be useful in predicting the dependency of ocular bioavailability on various formulation parameters, such as drug concentration, salinity, viscosity, etc. Mathematical modeling has been developed for each of the routes and validated by comparison with experiments. The individual models can be combined into a system model to predict the fraction of the instilled drug that reaches the target. This review summarizes the individual models for the transport of drugs across the cornea and conjunctiva and the canaliculi tear drainage. It also summarizes the combined tear dynamics model that can predict the ocular bioavailability of drugs instilled as eye drops. The predictions from the individual models and the combined model are in good agreement with experimental data. Both experiments and models predict that the corneal bioavailability for drugs delivered through eye drops is less than 5% due to the small area of the cornea in comparison to the conjunctiva, and the rapid clearance of the instilled solution by tear drainage. A contact lens is a natural choice for delivering drugs to the cornea due to the placement of the contact in the immediate vicinity of the cornea. The drug released by the contact towards the cornea surface is trapped in the post lens tear film for extended duration of at least 30min allowing transport of a large portion into the cornea. The model predictions backed by in vivo animal and clinical data show that the bioavailability increases to about 50% with contact lenses. This realization has encouraged considerable research towards delivering ocular drugs by contact lenses. Commercial contacts are, however, not ideal for drug delivery due to the short release durations which may necessitate wearing multiple lenses each day, reducing the viability of this approach. Recent research has focused on designing contacts that retain all critical properties while increasing the release durations to a few hours or a few days. Beagle dog studies with contact lenses containing vitamin E nanobarriers to attenuate drug transport have shown promising results. Human studies using contacts for drug delivery have also been conducted for allergy therapy but drug eluting contacts are not available in the market for any therapy.
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Partenhauser A, Bernkop-Schnürch A. Mucoadhesive polymers in the treatment of dry X syndrome. Drug Discov Today 2016; 21:1051-62. [DOI: 10.1016/j.drudis.2016.02.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/05/2016] [Accepted: 02/23/2016] [Indexed: 11/29/2022]
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Gronkiewicz KM, Giuliano EA, Sharma A, Mohan RR. Effects of topical hyaluronic acid on corneal wound healing in dogs: a pilot study. Vet Ophthalmol 2016; 20:123-130. [DOI: 10.1111/vop.12379] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kristina M. Gronkiewicz
- Veterinary Medicine and Surgery; University of Missouri; Columbia, 900 East Campus Drive MO 65211 USA
| | - Elizabeth A. Giuliano
- Veterinary Medicine and Surgery; University of Missouri; Columbia, 900 East Campus Drive MO 65211 USA
| | - Ajay Sharma
- Veterinary Medicine and Surgery; University of Missouri; Columbia, 900 East Campus Drive MO 65211 USA
- Harry S. Truman Memorial Veteran Hospital; Columbia MO USA
| | - Rajiv R. Mohan
- Veterinary Medicine and Surgery; University of Missouri; Columbia, 900 East Campus Drive MO 65211 USA
- Harry S. Truman Memorial Veteran Hospital; Columbia MO USA
- Mason Eye Institute; School of Medicine; Columbia MO USA
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Zeng W, Li Q, Wan T, Liu C, Pan W, Wu Z, Zhang G, Pan J, Qin M, Lin Y, Wu C, Xu Y. Hyaluronic acid-coated niosomes facilitate tacrolimus ocular delivery: Mucoadhesion, precorneal retention, aqueous humor pharmacokinetics, and transcorneal permeability. Colloids Surf B Biointerfaces 2016; 141:28-35. [PMID: 26820107 DOI: 10.1016/j.colsurfb.2016.01.014] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 01/06/2016] [Accepted: 01/06/2016] [Indexed: 01/01/2023]
Abstract
Tacrolimus (FK506) was used to prevent corneal allograft rejection in patients who were resistant to steroids and cyclosporine. However, the formulation for FK506 ocular delivery remained a challenge due to the drug's high hydrophobicity, high molecular weight, and eye's physiological and anatomical constraints. The aim of this project is to develop an ocular delivery system for FK506 based on a combined strategy of niosomes and mucoadhesive hyaluronic acid (HA), i.e., FK506HA-coated niosomes, which exploits virtues of both niosomes and HA to synergistically improve ophthalmic bioavailability. The FK506HA-coated niosomes were characterized with particle size, zeta potential, and rheology behavior. Mucoadhesion of FK506HA-coated niosomes to mucin was investigated through surface plasmon resonance in comparison with non-coated niosomes and HA solution. The results showed that niosomes possessed adhesion to mucin, and HA coating enhanced the adhesion. The in vivo precorneal retention was evaluated in rabbit, and the results showed that HA-coated niosomes prolonged the residence of FK506 significantly in comparison with non-coated niosomes or suspension. Aqueous humor pharmacokinetics test showed that area under curve of HA-coated niosomes was 2.3-fold and 1.2-fold as that of suspension and non-coated niosomes, respectively. Moreover, the synergetic corneal permeability enhancement of the hybrid delivery system on FK506 was visualized and confirmed by confocal laser scanning microscope. Overall, the results indicated that the hybrid system facilitated FK506 ocular delivery on mucoadhesion, precorneal retention, aqueous humor pharmacokinetics and transcorneal permeability. Therefore, HA-coated niosomes may be a promising approach for ocular targeting delivery of FK506.
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Affiliation(s)
- Weidong Zeng
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Qi Li
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Tao Wan
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Cui Liu
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Wenhui Pan
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Zushuai Wu
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Guoguang Zhang
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Jingtong Pan
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Mengyao Qin
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Yuanyuan Lin
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Chuanbin Wu
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Yuehong Xu
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China.
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Undefined role of mucus as a barrier in ocular drug delivery. Eur J Pharm Biopharm 2015; 96:442-6. [DOI: 10.1016/j.ejpb.2015.02.032] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 02/20/2015] [Accepted: 02/28/2015] [Indexed: 11/16/2022]
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Dienes L, Kiss HJ, Perényi K, Szepessy Z, Nagy ZZ, Barsi Á, Acosta MC, Gallar J, Kovács I. The Effect of Tear Supplementation on Ocular Surface Sensations during the Interblink Interval in Patients with Dry Eye. PLoS One 2015; 10:e0135629. [PMID: 26302222 PMCID: PMC4547761 DOI: 10.1371/journal.pone.0135629] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 07/24/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the characteristics of ocular surface sensations and corneal sensitivity during the interblink interval before and after tear supplementation in dry eye patients. METHODS Twenty subjects (41.88±14.37 years) with dry eye symptoms were included in the dry eye group. Fourteen subjects (39.13±11.27 years) without any clinical signs and/or symptoms of dry eye were included in the control group. Tear film dynamics was assessed by non-invasive tear film breakup time (NI-BUT) in parallel with continuous recordings of ocular sensations during forced blinking. Corneal sensitivity to selective stimulation of corneal mechano-, cold and chemical receptors was assessed using a gas esthesiometer. All the measurements were made before and 5 min after saline and hydroxypropyl-guar (HP-guar) drops. RESULTS In dry eye patients the intensity of irritation increased rapidly after the last blink during forced blinking, while in controls there was no alteration in the intensity during the first 10 sec followed by an exponential increase. Irritation scores were significantly higher in dry eye patients throughout the entire interblink interval compared to controls (p<0.004). NI-BUT significantly increased after HP-guar (p = 0.003) but not after saline drops (p = 0.14). In both groups, either after saline or HP-guar the shape of symptom intensity curves remained the same with significantly lower irritation scores (p<0.004), however after HP-guar the decrease was significantly more pronounced (p<0.004). Corneal sensitivity to selective mechanical, cold and chemical stimulation decreased significantly in both groups after HP-guar (p<0.05), but not after saline drops (p>0.05). CONCLUSION Ocular surface irritation responses due to tear film drying are considerably increased in dry eye patients compared to normal subjects. Although tear supplementation improves the protective tear film layer, and thus reduce unpleasant sensory responses, the rapid rise in discomfort is still maintained and might be responsible for the remaining complaints of dry eye patients despite the treatment.
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Affiliation(s)
- Lóránt Dienes
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Huba J Kiss
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Kristóf Perényi
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | | | - Zoltán Z Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Árpád Barsi
- Department of Photogrammetry and Geoinformatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - M Carmen Acosta
- Instituto de Neurociencias, Universidad Miguel Hernandez-CSIC, San Juan de Alicante, Spain
| | - Juana Gallar
- Instituto de Neurociencias, Universidad Miguel Hernandez-CSIC, San Juan de Alicante, Spain
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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Kaya S, Schmidl D, Schmetterer L, Witkowska KJ, Unterhuber A, Aranha dos Santos V, Baar C, Garhöfer G, Werkmeister RM. Effect of hyaluronic acid on tear film thickness as assessed with ultra-high resolution optical coherence tomography. Acta Ophthalmol 2015; 93:439-443. [PMID: 25601227 DOI: 10.1111/aos.12647] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 11/30/2014] [Indexed: 12/23/2022]
Abstract
PURPOSE The aim of this study was to assess the effect of a single drop of hyaluronic acid on tear film thickness (TFT) in healthy subjects. METHODS Sixteen healthy subjects (eight male/eight female) aged between 20 and 36 years were included in this randomized, double-masked placebo-controlled study. One eye received a single dose of hyaluronic acid (Olixia pure(®) ; Croma Pharma, Korneuburg, Austria) eye drops, and the fellow eye received physiologic saline solution as placebo control. The study eye was chosen randomly. TFT as measured with a custom-built Fourier-domain optical coherence tomography (FD-OCT) system was the main outcome variable and measured before and every 10 min until 1 hr after topical administration. RESULTS Baseline TFT was 4.8 ± 0.5 μm in the study eye and 5.0 ± 0.4 μm in the control eyes. Hyaluronic acid significantly increased TFT (p = 0.008 versus placebo) with a maximum effect 10 min after instillation (13.9 ± 11.9%). Post hoc analysis revealed that an increase in TFT was seen until 30 min after administration compared to placebo. Data in the placebo group show high reproducibility with an intraclass correlation coefficient of 0.93 and a coefficient of variation of 5.4 ± 3.3%. CONCLUSION The data of this study indicate that hyaluronic acid increases TFT for as long as 30 min in healthy subjects. In addition, our data provide evidence that our custom-built OCT system is capable of measuring residence time of lubricants on the ocular surface.
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Affiliation(s)
- Semira Kaya
- Center for Medical Physics and Biomedical Engineering; Medical University of Vienna; Vienna Austria
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
- Department of Ophthalmology; Paracelsus University Salzburg; Salzburg Austria
| | - Doreen Schmidl
- Center for Medical Physics and Biomedical Engineering; Medical University of Vienna; Vienna Austria
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - Leopold Schmetterer
- Center for Medical Physics and Biomedical Engineering; Medical University of Vienna; Vienna Austria
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - Katarzyna J. Witkowska
- Center for Medical Physics and Biomedical Engineering; Medical University of Vienna; Vienna Austria
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - Angelika Unterhuber
- Center for Medical Physics and Biomedical Engineering; Medical University of Vienna; Vienna Austria
| | | | - Carina Baar
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - René M. Werkmeister
- Center for Medical Physics and Biomedical Engineering; Medical University of Vienna; Vienna Austria
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Tear Film Thickness After Treatment With Artificial Tears in Patients With Moderate Dry Eye Disease. Cornea 2015; 34:421-6. [DOI: 10.1097/ico.0000000000000358] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Serés C, Quevedo L, Cardona G, Blanch EL, Augé M. Tear break-up time for tear film evaluation: Are moistening solutions interchangeable? Cont Lens Anterior Eye 2015; 38:272-6. [PMID: 25814428 DOI: 10.1016/j.clae.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 01/15/2015] [Accepted: 03/02/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE It was the main purpose of this study to investigate the influence of the moistening solution on TBUT measurements in an asymptomatic population. METHODS An online survey was employed to determine the compliance of Spanish eye care practitioners with the recommended normalized procedure to administer TBUT. For the purpose of examining the clinical relevance of discrepancies from the recommended procedure, a randomized, double-masked, bilateral study was designed in which a micropipette was used to moisten fluorescein strips with a controlled volume of six different solutions, commonly available in the contact lens office, and TBUT was measured in 58 non-dry eye (OSDI<15) subjects (age from 19 to 32 years). RESULTS Results from the online survey revealed that 64% of Spanish practitioners frequently use (or have used) different solutions to moisten fluorescein strips during TBUT assessment. Statistically significant differences in TBUT values were found between the various solutions as a whole (χ(2)=198.384, p<0.001), as well as between all solutions when explored pair-wise (all p<0.001), except for the two saline solutions. CONCLUSIONS The present findings support the relevance of selecting the appropriate solution when conducting TBUT for the evaluation of the tear film. Deviations from the recommended procedure may result in misdiagnosis of dry eye and unnecessary patient referral.
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Affiliation(s)
- Carme Serés
- Research Group of Centre Universitari de la Visió, Optics and Optometry Department, Technical University of Catalonia, Spain
| | - Lluïsa Quevedo
- Research Group of Centre Universitari de la Visió, Optics and Optometry Department, Technical University of Catalonia, Spain
| | - Genís Cardona
- Research Group of Centre Universitari de la Visió, Optics and Optometry Department, Technical University of Catalonia, Spain.
| | - Estel la Blanch
- Research Group of Centre Universitari de la Visió, Optics and Optometry Department, Technical University of Catalonia, Spain
| | - Montserrat Augé
- Research Group of Centre Universitari de la Visió, Optics and Optometry Department, Technical University of Catalonia, Spain
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Kim HY, Park YM, Lee JS. Effect of Preservative-Free Healon Eye Drop on Human Corneal Epithelial Cell in Vitro. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.11.1698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ho Yun Kim
- Department of Ophthalmology, Pusan National University Hospital, Busan, Korea
| | - Young Min Park
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jong Soo Lee
- Department of Ophthalmology, Pusan National University Hospital, Busan, Korea
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
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Astakhov YS, Astakhov SY, Lisochkina AB. Assessment of dry eye signs and symptoms and ocular tolerance of a preservative-free lacrimal substitute (Hylabak®) versus a preserved lacrimal substitute (Systane®) used for 3 months in patients after LASIK. Clin Ophthalmol 2013; 7:2289-97. [PMID: 24353401 PMCID: PMC3862698 DOI: 10.2147/opth.s50446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Laser-assisted in situ keratomileusis (LASIK) is commonly used to correct refractive defects. The procedure frequently results in dry eye symptoms, usually of short but sometimes longer duration. This study was designed to assess dry eye and ocular tolerability after LASIK in patients treated with a preservative-free lacrimal substitute (Hylabak®) or preserved lacrimal substitute (Systane®). In a single-center, investigator-masked, prospective, noninferiority, clinical study, patients undergoing LASIK surgery were randomized to receive Hylabak or Systane eye drops (one drop in each eye four times daily for 3 months). Fluorescein test scores were the primary efficacy variable and were similar on day 1 (mean 0.26 and 0.28 for Hylabak and Systane, respectively). At the final visit (day 84 ± 3) the fluorescein scores had improved to 0.11 and 0.04, respectively. The difference was not significant and thus noninferiority was established. A trend of more rapid improvement in the Hylabak group was evident. Both treatments were well tolerated and there were no serious adverse events, discontinuations for adverse events or other safety-related reasons, and no systemic adverse events. The results suggest that Hylabak is not less effective than Systane in reducing the symptoms of dry eye after LASIK surgery.
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Affiliation(s)
- Yuri S Astakhov
- University Department of Ophthalmology, State Educational Establishment of Higher Professional Education, Saint Petersburg Pavlov State Medical University and of the Federal Service for Surveillance of Healthcare and Social Development of the Russian Federation, St Petersburg, Russia
| | - Sergei Y Astakhov
- University Department of Ophthalmology, State Educational Establishment of Higher Professional Education, Saint Petersburg Pavlov State Medical University and of the Federal Service for Surveillance of Healthcare and Social Development of the Russian Federation, St Petersburg, Russia
| | - Alla B Lisochkina
- University Department of Ophthalmology, State Educational Establishment of Higher Professional Education, Saint Petersburg Pavlov State Medical University and of the Federal Service for Surveillance of Healthcare and Social Development of the Russian Federation, St Petersburg, Russia
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Dogru M, Nakamura M, Shimazaki J, Tsubota K. Changing trends in the treatment of dry-eye disease. Expert Opin Investig Drugs 2013; 22:1581-601. [DOI: 10.1517/13543784.2013.838557] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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The effect of pH, dilution, and temperature on the viscosity of ocular lubricants--shift in rheological parameters and potential clinical significance. Eye (Lond) 2012; 26:1579-84. [PMID: 23079749 DOI: 10.1038/eye.2012.211] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To investigate the effect of temperature, dilution, and pH on the viscosity of ocular lubricants. DESIGN Laboratory based investigation of viscosity. PARTICIPANTS No human subjects. METHODS Hypromellose 0.3%, sodium hyaluronate 0.4%, carboxymethylcellulose sodium 0.5%/glycerin 0.9%, and carmellose sodium 0.5% were investigated. Ostwald capillary viscometers were utilised for viscosity measurements. The kinematic viscosity of each lubricant was tested quantitatively from 22 to 40 °C, and over a pH range of 5-8 under isothermal conditions. The kinematic viscosity of each eye drop was also tested under dilution by varying the mass fraction of each eye drop under isothermal conditions. MAIN OUTCOME MEASURE Changes in kinematic viscosity. RESULTS Hypromellose 0.3% had an initial pH of 8.34, while the other lubricants had a pH close to neutral. From 22 to 35 °C, the kinematic viscosity of sodium hyaluronate 0.4 fell by 36% from 37.8 to 24.4 mm(2)/s, carboxymethylcellulose sodium 0.5%/glycerin 0.9% fell by 35% from 16.98 to 11.1 mm(2)/s, hypromellose fell by 37% from 6.89 to 3.69 mm(2)/s, and carmellose sodium 0.5% fell by 25% from 2.77 to 1.87 mm(2)/s. At 32 °C only sodium hyaluronate 0.4%, and carboxymethylcellulose sodium 0.5%/glycerin 0.9% retained sufficient kinematic viscosity to maintain precorneal residence. Kinematic viscosities of all the topical lubricants were unaffected by pH but decreased significantly with dilution. CONCLUSIONS This study suggests that currently used ocular lubricants have limited bioavailability due to reductions in viscosity by temperature and dilutional changes under physiological conditions. Developing lubricants with stable viscosities may maximise therapeutic efficacy.
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Yang G, Espandar L, Mamalis N, Prestwich GD. A cross-linked hyaluronan gel accelerates healing of corneal epithelial abrasion and alkali burn injuries in rabbits. Vet Ophthalmol 2010; 13:144-50. [DOI: 10.1111/j.1463-5224.2010.00771.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
PURPOSE Quantitative understanding of tear dynamics may help in developing better ophthalmic drug delivery vehicles and dry eye treatments. This paper attempts to develop a comprehensive model that can predict the effect of physiological parameters on various issues related to tear dynamics. METHODS The model is based on mass balances of water and solutes such as glucose, sodium, potassium, and chloride. The mass balances require models for the drainage of fluid through the canaliculi and the transport of tears and solutes through the conjunctiva. The model parameters are obtained by simulating Ussing-chamber experiments. The differential equations for the unsteady balances are solved numerically. RESULTS The model predicts that under normal conditions, the tear volume, tear osmolarity and potential are 7.1 microl, 297.6 mM, and -15.1 mV, respectively. The model also predicts that the conjunctiva is secretory and contributes about 25% of the total tear production. We also predict the effect of evaporation on tear physiology and show that an increase in evaporation increases osmolarity, reduces tear volume, and increases conjuctival secretion. Additionally, the new tear dynamics model helps assess the effect of osmolarity of the instilled drops, insertion of punctum plugs and use of moisture chamber as treatments for dry eyes. Furthermore, the model is used to predict the effect of modulation of specific transport pathways, which is proposed as a potential remedy for dry eyes, on conjuctival secretion and total tear volume. CONCLUSIONS Most of the predicted results agree with the reported experimental results, at least qualitatively. However, some predictions disagree with experiments suggesting that further improvements in the model are needed. The model developed in this paper can improve our understanding of tear dynamics and also serve as a tool to evaluate the efficacy of various modalities at treating dry eyes.
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Affiliation(s)
- Heng Zhu
- Chemical Engineering Department, University of Florida, Gainesville, Florida 32611-6005, USA
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Abstract
PURPOSE In this paper we develop a mathematical model that can predict the steady-state tear film thickness and the dynamic tear film thickness and the solute concentration after instillation of a solute-laden fluid in the eye. METHODS The mathematical model developed in this paper is based on a balance between the inflow and outflow of tears into the tear film. It incorporates a tear drainage model and a model that relates the tear film thickness to the meniscus radius of curvature. To predict the solute concentrations, the tear balance is coupled with the solute balance. The differential equations for the unsteady balances are solved numerically. RESULTS The model predicts that the tear film thickness depends on a number of physiological factors, such as rates of tear production and evaporation, geometry and modulus of the canaliculi, and surface tension and viscosity of tears, and varies from about 3 to 15 microm. The model also predicts that the drainage time for an instilled volume of 15 microl is 1283 s. Additionally, the time required for the tracer concentration to decay to 1% of the value immediately after instillation of a drug-laden 40 microl drop is about 2480 s. Similarly, the time for intensity decay for a radioactive tracer after 25 microl instillation is about 1566 s. Also, the model predicts that the fraction of the instilled drug that reaches the cornea is about 1.3% for topical application of timolol. CONCLUSIONS The predicted results agree reasonably with the reported experimental results, at least qualitatively. The model developed here can serve as a useful tool to develop a more precise understanding of various issues related to tears and also evaluate the effect of various parameters on the tear volume.
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Affiliation(s)
- Heng Zhu
- Chemical Engineering Department, University of Florida, Gainesville, Florida 32611-6005, USA
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Kapoor Y, Thomas JC, Tan G, John VT, Chauhan A. Surfactant-laden soft contact lenses for extended delivery of ophthalmic drugs. Biomaterials 2009; 30:867-78. [DOI: 10.1016/j.biomaterials.2008.10.032] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 10/16/2008] [Indexed: 11/25/2022]
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