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Bhujel B, Oh SH, Kim CM, Yoon YJ, Chung HS, Ye EA, Lee H, Kim JY. Current Advances in Regenerative Strategies for Dry Eye Diseases: A Comprehensive Review. Bioengineering (Basel) 2023; 11:39. [PMID: 38247916 PMCID: PMC10813666 DOI: 10.3390/bioengineering11010039] [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: 11/20/2023] [Revised: 12/17/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024] Open
Abstract
Dry eye disease (DED) is an emerging health issue affecting millions of individuals annually. Ocular surface disorders, such as DED, are characterized by inflammation triggered by various factors. This condition can lead to tear deficiencies, resulting in the desiccation of the ocular surface, corneal ulceration/perforation, increased susceptibility to infections, and a higher risk of severe visual impairment and blindness. Currently, the clinical management of DED primarily relies on supportive and palliative measures, including the frequent and lifelong use of different lubricating agents. While some advancements like punctal plugs, non-steroidal anti-inflammatory drugs, and salivary gland autografts have been attempted, they have shown limited effectiveness. Recently, there have been promising developments in the treatment of DED, including biomaterials such as nano-systems, hydrogels, and contact lenses for drug delivery, cell-based therapies, biological approaches, and tissue-based regenerative therapy. This article specifically explores the different strategies reported so far for treating DED. The aim is to discuss their potential as long-term cures for DED while also considering the factors that limit their feasibility and effectiveness. These advancements offer hope for more effective and sustainable treatment options in the future.
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Affiliation(s)
| | | | | | | | | | | | | | - Jae-Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea; (B.B.); (S.-H.O.); (C.-M.K.); (Y.-J.Y.); (H.-S.C.); (E.-A.Y.); (H.L.)
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Sun H, Wang G, Feng Q, Liu S. Polymer-Based Self-Assembled Drug Delivery Systems for Glaucoma Treatment: Design Strategies and Recent Advances. Polymers (Basel) 2023; 15:4466. [PMID: 38006190 PMCID: PMC10675782 DOI: 10.3390/polym15224466] [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: 09/14/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
Glaucoma has become the world's leading cause of irreversible blindness, and one of its main characteristics is high intraocular pressure. Currently, the non-surgical drug treatment scheme to reduce intraocular pressure is a priority method for glaucoma treatment. However, the complex and special structure of the eye poses significant challenges to the treatment effect and safety adherence of this drug treatment approach. To address these challenges, the application of polymer-based self-assembled drug delivery systems in glaucoma treatment has emerged. This review focuses on the utilization of polymer-based self-assembled structures or materials as important functional and intelligent carriers for drug delivery in glaucoma treatment. Various drug delivery systems, such as eye drops, hydrogels, and contact lenses, are discussed. Additionally, the review primarily summarizes the design strategies and methods used to enhance the treatment effect and safety compliance of these polymer-based drug delivery systems. Finally, the discussion delves into the new challenges and prospects of employing polymer-based self-assembled drug delivery systems for the treatment of glaucoma.
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Affiliation(s)
- Hao Sun
- School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin 150080, China;
- Zhengzhou Research Institute, Harbin Institute of Technology, Zhengzhou 450000, China
| | - Guangtong Wang
- Zhengzhou Research Institute, Harbin Institute of Technology, Zhengzhou 450000, China
- School of Medicine and Health, Harbin Institute of Technology, Harbin 150080, China
| | - Qingying Feng
- School of Life Science and Technology, Harbin Institute of Technology, Harbin 150080, China;
| | - Shaoqin Liu
- School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin 150080, China;
- Zhengzhou Research Institute, Harbin Institute of Technology, Zhengzhou 450000, China
- School of Medicine and Health, Harbin Institute of Technology, Harbin 150080, China
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Ioniță M, Vlăsceanu GM, Toader AG, Manole M. Advances in Therapeutic Contact Lenses for the Management of Different Ocular Conditions. J Pers Med 2023; 13:1571. [PMID: 38003886 PMCID: PMC10672201 DOI: 10.3390/jpm13111571] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
In the advent of an increasingly aging population and due to the popularity of electronic devices, ocular conditions have become more prevalent. In the world of medicine, accomplishing eye medication administration has always been a difficult task. Despite the fact that there are many commercial eye drops, most of them have important limitations, due to quick clearance mechanisms and ocular barrers. One solution with tremendous potential is the contact lens used as a medication delivery vehicle to bypass this constraint. Therapeutic contact lenses for ocular medication delivery have attracted a lot of attention because they have the potential to improve ocular bioavailability and patient compliance, both with minimal side effects. However, it is essential not to compromise essential features such as water content, optical transparency, and modulus to attain positive in vitro and in vivo outcomes with respect to a sustained drug delivery profile from impregnated contact lenses. Aside from difficulties like drug stability and burst release, the changing of lens physico-chemical features caused by therapeutic or non-therapeutic components can limit the commercialization potential of pharmaceutical-loaded lenses. Research has progressed towards bioinspired techniques and smart materials, to improve the efficacy of drug-eluting contact lenses. The bioinspired method uses polymeric materials, and a specialized molecule-recognition technique called molecular imprinting or a stimuli-responsive system to improve biocompatibility and support the drug delivery efficacy of drug-eluting contact lenses. This review encompasses strategies of material design, lens manufacturing and drug impregnation under the current auspices of ophthalmic therapies and projects an outlook onto future opportunities in the field of eye condition management by means of an active principle-eluting contact lens.
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Affiliation(s)
- Mariana Ioniță
- Faculty of Medical Engineering, University Politehnica of Bucharest, 011061 Bucharest, Romania;
- Advanced Polymer Materials Group, University Politehnica of Bucharest, 011061 Bucharest, Romania
- ebio-Hub Research Centre, University Politehnica of Bucharest-Campus, 061344 Bucharest, Romania
| | - George Mihail Vlăsceanu
- Faculty of Medical Engineering, University Politehnica of Bucharest, 011061 Bucharest, Romania;
- Advanced Polymer Materials Group, University Politehnica of Bucharest, 011061 Bucharest, Romania
| | - Alin Georgian Toader
- Faculty of Medical Engineering, University Politehnica of Bucharest, 011061 Bucharest, Romania;
| | - Marius Manole
- Department of Prosthetics and Dental Materials, Faculty of Dentistry, University of Medicine and Pharmacy "Iuliu Hatieganu", 400012 Cluj-Napoca, Romania
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Toffoletto N, Saramago B, Serro AP, Chauhan A. A Physiology-Based Mathematical Model to Understand Drug Delivery from Contact Lenses to the Back of the Eye. Pharm Res 2023; 40:1939-1951. [PMID: 37498499 PMCID: PMC10447275 DOI: 10.1007/s11095-023-03560-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/02/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE Therapeutic contact lenses, able to store drug and deliver it to the eye surface in a sustained fashion, gained interest as an effective and patient-friendly alternative to eye drops. Recent animal studies also demonstrated the presence of therapeutic drug levels in the back of the eye after wearing drug-loaded contact lenses, thus opening the possibility of treating the posterior segment without need of invasive intraocular injections. The drug pathways from contact lenses to the back of the eye require further investigation. METHODS A mechanistic mathematical model was developed to evaluate the drug concentration over time in the tears, sclera and choroid, retina, aqueous humor and vitreous humor after the application of a therapeutic contact lens. The main drug transport mechanisms of the eye and the barrier properties of the different tissues were included in the model. Validation was performed by comparison with experimental data in literature. RESULTS The model predictions of drug concentration over time reflected the experimental data both in the anterior and posterior segment of the eye. The model can differentiate between contributions to transport from different pathways. CONCLUSIONS The model constitutes a first step towards the possibility of predicting the ocular drug distribution and the treatment efficacy in the early stage of contact lens development, and it may help reduce both the need for in vivo tests (with ethical and economic advantages) and the gap between the lens design and clinical application. It also allows for an improved understanding of drug transport in the eye.
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Affiliation(s)
- Nadia Toffoletto
- Centro de Química Estrutural, Institute of Molecular Sciences, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001, Lisbon, Portugal.
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal.
| | - Benilde Saramago
- Centro de Química Estrutural, Institute of Molecular Sciences, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001, Lisbon, Portugal
| | - Ana Paula Serro
- Centro de Química Estrutural, Institute of Molecular Sciences, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001, Lisbon, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal
| | - Anuj Chauhan
- Chemical and Biological Engineering Department, Colorado School of Mines, Golden, CO, 80401, USA
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Hong Y, Fang Q, Bai T, Zhao P, Han Y, Lin Q. Cascade reaction triggering and photothermal AuNPs@MIL MOFs doped intraocular lens for enhanced posterior capsular opacification prevention. J Nanobiotechnology 2023; 21:134. [PMID: 37095517 PMCID: PMC10127092 DOI: 10.1186/s12951-023-01897-0] [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: 02/16/2023] [Accepted: 04/16/2023] [Indexed: 04/26/2023] Open
Abstract
Posterior capsular opacification (PCO) is the most common complication after cataract surgery. Present strategies can't meet the clinical needs of long-term prevention. This research reports a novel intraocular lens (IOL) bulk material with high biocompatibility and synergistic therapy. Gold nanoparticles (AuNPs) doped MIL-101-NH2 metal-organic frameworks (MOFs) (AuNPs@MIL) was firstly fabricated via in situ reductions. Then the functionalized MOFs were uniformly mixed with glycidyl methacrylate (GMA) and 2-(2-ethoxyethoxy) ethyl acrylate (EA) to form the nanoparticle doped polymer (AuNPs@MIL-PGE), and which was used to fabricate IOL bulk materials. The materials' optical and mechanical properties with different mass contents of nanoparticles are investigated. Such bulk functionalized IOL material could efficiently remove residual human lens epithelial cells (HLECs) in the capsular bag in the short term, and can prevent PCO on demand in the long run by near-infrared illumination (NIR) action. In vivo and in vitro experiments demonstrate the biosafety of the material. The AuNPs@MIL-PGE exhibits excellent photothermal effects, which could inhibit cell proliferation under NIR and doesn't cause pathological effects on the surrounding tissues. Such functionalized IOL can not only avoid the side effects of the antiproliferative drugs but also realize the enhanced PCO prevention in clinical practice.
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Affiliation(s)
- Yueze Hong
- National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Qiuna Fang
- National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Ting Bai
- National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Peiyi Zhao
- National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Yuemei Han
- National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Quankui Lin
- National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
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Cvenkel B, Kolko M. Devices and Treatments to Address Low Adherence in Glaucoma Patients: A Narrative Review. J Clin Med 2022; 12:jcm12010151. [PMID: 36614952 PMCID: PMC9821329 DOI: 10.3390/jcm12010151] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/05/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Poor adherence to topical glaucoma medications has been linked to worse visual field outcomes in glaucoma patients. Therefore, identifying and overcoming the adherence barriers are expected to slow down the progression of disease. The most common barriers to adherence, in addition to the lack of knowledge, include forgetfulness, side effects of medications, difficulties with drop instillation and low self-efficacy. Symptoms and signs of ocular surface disease, which importantly reduce patients' quality of life, are decreased by using preservative-free topical medications. Sustained drug delivery systems using different vehicles seem promising for relieving the burden of drop administration. Currently, only the bimatoprost sustained-release intracameral implant is available for clinical use and single administration. In the era of digitalization, smart drug delivery-connected devices may aid adherence and, by sharing data with care providers, improve monitoring and adjusting treatment. Selective laser trabeculoplasty as first-line treatment delays the need for drops, whereas minimally invasive glaucoma procedures with and without devices combined with cataract surgery increase the likelihood of patients with early-to-moderate glaucoma to remain drop free or reduce the number of drops needed to control intraocular pressure. The aim of this narrative review is to present and discuss devices and treatments that may improve adherence by reducing the need for drops and side effects of medications and aiding in glaucoma monitoring. For the future, there is a need for studies focusing on clinically important outcomes, quality of life and the cost of intervention with longer post-interventional follow up.
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Affiliation(s)
- Barbara Cvenkel
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence:
| | - Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, 2600 Glostrup, Denmark
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Chauhan A, Fitzhenry L, Serro AP. Recent Advances in Ophthalmic Drug Delivery. Pharmaceutics 2022; 14:pharmaceutics14102075. [PMID: 36297511 PMCID: PMC9606937 DOI: 10.3390/pharmaceutics14102075] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Anuj Chauhan
- Chemical and Biological Engineering, Colorado School of Mines, Golden, CO 80401, USA
| | - Laurence Fitzhenry
- Ocular Therapeutics Research Group (OTRG), Pharmaceutical and Molecular Biotechnology Research Centre, Department of Science, South East Technological University, X91 K0EK Waterford, Ireland
| | - Ana Paula Serro
- Centro de Química Estrutural, Institute of Molecular Sciences, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
- Correspondence:
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Garkal A, Bangar P, Rajput A, Pingale P, Dhas N, Sami A, Mathur K, Joshi S, Dhuri S, Parikh D, Mutalik S, Mehta T. Long-acting formulation strategies for protein and peptide delivery in the treatment of PSED. J Control Release 2022; 350:538-568. [PMID: 36030993 DOI: 10.1016/j.jconrel.2022.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 12/17/2022]
Abstract
The invigoration of protein and peptides in serious eye disease includes age-related macular degeneration, choroidal neovascularization, retinal neovascularization, and diabetic retinopathy. The transportation of macromolecules like aptamers, recombinant proteins, and monoclonal antibodies to the posterior segment of the eye is challenging due to their high molecular weight, rapid degradation, and low solubility. Moreover, it requires frequent administration for prolonged therapy. The long-acting novel formulation strategies are helpful to overcome these issues and provide superior therapy. It avoids frequent administration, improves stability, high retention time, and avoids burst release. This review briefly enlightens posterior segments of eye diseases with their diagnosis techniques and treatments. This article mainly focuses on recent advanced approaches like intravitreal implants and injectables, electrospun injectables, 3D printed drug-loaded implants, nanostructure thin-film polymer devices encapsulated cell technology-based intravitreal implants, injectable and depots, microneedles, PDS with ranibizumab, polymer nanoparticles, inorganic nanoparticles, hydrogels and microparticles for delivering macromolecules in the eye for intended therapy. Furthermore, novel techniques like aptamer, small Interference RNA, and stem cell therapy were also discussed. It is predicted that these systems will make revolutionary changes in treating posterior segment eye diseases in future.
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Affiliation(s)
- Atul Garkal
- Department of Pharmaceutics, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat 382481, India
| | - Priyanka Bangar
- Department of Pharmaceutics, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat 382481, India
| | - Amarjitsing Rajput
- Department of Pharmaceutics, Bharti Vidyapeeth Deemed University, Poona College of Pharmacy, Pune, Maharashtra 411038, India
| | - Prashant Pingale
- Department of Pharmaceutics, GES's Sir Dr. M.S. Gosavi College of Pharmaceutical Education and Research, Nashik, Maharashtra 422005, India
| | - Namdev Dhas
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka 576104, India
| | - Anam Sami
- Department of Pharmaceutics, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat 382481, India
| | - Khushboo Mathur
- Department of Pharmaceutics, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat 382481, India
| | - Shubham Joshi
- Department of Pharmaceutics, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat 382481, India
| | - Sonika Dhuri
- Department of Pharmaceutics, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat 382481, India
| | - Dhaivat Parikh
- Department of Pharmaceutics, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat 382481, India
| | - Srinivas Mutalik
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka 576104, India
| | - Tejal Mehta
- Department of Pharmaceutics, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat 382481, India.
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Luo C, Wang H, Chen X, Xu J, Yin H, Yao K. Recent Advances of Intraocular Lens Materials and Surface Modification in Cataract Surgery. Front Bioeng Biotechnol 2022; 10:913383. [PMID: 35757812 PMCID: PMC9213654 DOI: 10.3389/fbioe.2022.913383] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Advances in cataract surgery have increased the demand for intraocular lens (IOL) materials. At present, the progress of IOL materials mainly contains further improving biocompatibility, providing better visual quality and adjustable ability, reducing surgical incision, as well as dealing with complications such as posterior capsular opacification (PCO) and ophthalmitis. The purpose of this review is to describe the research progress of relevant IOL materials classified according to different clinical purposes. The innovation of IOL materials is often based on the common IOL materials on the market, such as silicon and acrylate. Special properties and functions are obtained by adding extra polymers or surface modification. Most of these studies have not yet been commercialized, which requires a large number of clinical trials. But they provide valuable thoughts for the optimization of the IOL function.
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Affiliation(s)
- Chenqi Luo
- Eye Center of the Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Hanle Wang
- Eye Center of the Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Xinyi Chen
- Eye Center of the Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Jingjie Xu
- Eye Center of the Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Houfa Yin
- Eye Center of the Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Ke Yao
- Eye Center of the Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
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Pereira-da-Mota AF, Vivero-Lopez M, Serramito M, Diaz-Gomez L, Serro AP, Carracedo G, Huete-Toral F, Concheiro A, Alvarez-Lorenzo C. Contact lenses for pravastatin delivery to eye segments: Design and in vitro-in vivo correlations. J Control Release 2022; 348:431-443. [PMID: 35688348 DOI: 10.1016/j.jconrel.2022.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/12/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
Abstract
Oral administration of cholesterol-lowering statins, HMG-CoA reductase inhibitors, is associated with beneficial effects on eye conditions. This work aims to design contact lenses (CLs) that can sustainedly deliver pravastatin and thus improve the ocular efficacy while avoiding systemic side effects of statins. Bioinspired hydrogels were prepared with monomers that resemble hydrophobic (ethylene glycol phenyl ether methacrylate) and amino (2-aminoethyl methacrylamide hydrochloride) functionalities of the active site of HMG-CoA. Best performing CLs loaded >6 mg/g, in vitro fulfilled the release demands for daily wearing, and showed anti-inflammatory activity (lowering TNF-α). High hydrostatic pressure sterilization preserved the stability of both the drug and the hydrogel network. Ex vivo tests revealed the ability of pravastatin to accumulate in cornea and sclera and to penetrate through transscleral route. In vivo tests (rabbits) confirmed that, compared to eye drops and for the same dose, CLs provided significantly higher pravastatin levels in tear fluid within 1 to 7 h of wearing. Moreover, after 8 h wearing pravastatin was present in cornea, sclera, aqueous humour and vitreous humour. Strong correlations between percentages of drug released in vitro and in vivo were found. Effects of volume and proteins on release rate and Levy plots were identified.
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Affiliation(s)
- Ana F Pereira-da-Mota
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma Group (GI-1645), Facultad de Farmacia, Instituto de Materiales (iMATUS) and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Maria Vivero-Lopez
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma Group (GI-1645), Facultad de Farmacia, Instituto de Materiales (iMATUS) and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Maria Serramito
- Ocupharm Research Group, Faculty of Optic and Optometry, University Complutense of Madrid, C/Arcos del Jalon 118, 28037 Madrid, Spain
| | - Luis Diaz-Gomez
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma Group (GI-1645), Facultad de Farmacia, Instituto de Materiales (iMATUS) and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Ana Paula Serro
- Centro de Química Estrutural, Institute of Molecular Sciences and Departamento de Engenharia Química, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
| | - Gonzalo Carracedo
- Ocupharm Research Group, Faculty of Optic and Optometry, University Complutense of Madrid, C/Arcos del Jalon 118, 28037 Madrid, Spain
| | - Fernando Huete-Toral
- Ocupharm Research Group, Faculty of Optic and Optometry, University Complutense of Madrid, C/Arcos del Jalon 118, 28037 Madrid, Spain
| | - Angel Concheiro
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma Group (GI-1645), Facultad de Farmacia, Instituto de Materiales (iMATUS) and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma Group (GI-1645), Facultad de Farmacia, Instituto de Materiales (iMATUS) and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain.
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11
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Moshirfar M, Peterson T, Ungricht E, McCabe S, Ronquillo YC, Brooks B, Towne F, Hoopes P. Thygeson Superficial Punctate Keratitis: A Clinical and Immunologic Review. Eye Contact Lens 2022; 48:232-238. [PMID: 35301272 DOI: 10.1097/icl.0000000000000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Thygeson superficial punctate keratitis (TSPK) is clinically characterized by exacerbations and remissions of gray-white opacities within the corneal epithelium, most often bilateral but may be asymmetric. Symptoms typically include photophobia, tearing, blurring, and eye irritation. Although disease progression and prognosis are well described, the exact cause is unknown. Hypotheses exist implicating virus-mediated immunity as the cause of TSPK following cases of viral keratitis; however, several polymerase chain reaction studies refute the infectious process concurrently with symptomatic TSPK. This is further supported by the consistent lack of response to antiviral and antibacterial treatment. A subset of dendritic cells known as Langerhans cells (LC) found within the corneal epithelium has been positively correlated with exacerbations of TSPK. Langerhans cells proliferate to protect and mitigate the cornea's inflammatory response, but the inflammatory triggers and relapses associated with TSPK are not well understood. Several topical drugs exist to treat inflammation related to TSPK; however, drug delivery is a major barrier to treatment because of the tear film and epithelial barrier. Drug-eluting contact lenses that target intermediates of inflammation could serve as a more effective treatment modality because of the increased bioavailability of the drugs. This review is an in-depth survey of the literature regarding the relationship between the origin and pathophysiology of LC and TSPK at the immunologic level. We also discuss potential pharmacotherapeutic interventions for TSPK prevention and treatment.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center (M.M., S.M., Y.C.R., P.H.), Hoopes Vision, Draper, UT; Department of Ophthalmology and Visual Sciences (M.M.), John A. Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, UT; Utah Lions Eye Bank (M.M.), Murray, UT; Rocky Vista University College of Osteopathic Medicine (T.P., D.B.B., F.T.), Ivins, UT; University of Utah School of Medicine (E.U.), Salt Lake City, UT; and Mission Hills Eye Center (S.M.), Pleasant Hill, CA
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Eftimie Totu E, Mănuc D, Totu T, Cristache CM, Buga RM, Erci F, Cristea C, Isildak I. Considerations on the Controlled Delivery of Bioactive Compounds through Hyaluronic Acid Membrane. MEMBRANES 2022; 12:membranes12030303. [PMID: 35323778 PMCID: PMC8949277 DOI: 10.3390/membranes12030303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 02/27/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022]
Abstract
(1) Background: The standard treatment for periodontal disease, a chronic inflammatory state caused by the interaction between biofilms generated by organized oral bacteria and the local host defense response, consists of calculus and biofilm removal through mechanical debridement, associated with antimicrobial therapy that could be delivered either systemically or locally. The present study aimed to determine the effectiveness of a hyaluronic acid membrane matrix as a carrier for the controlled release of the active compounds of a formulation proposed as a topical treatment for periodontal disease, and the influence of pH on the complex system’s stability. (2) Methods: The obtained hyaluronic acid (HA) hydrogel membrane with dispersed melatonin (MEL), metronidazole (MZ), and tetracycline (T) was completely characterized through FTIR, XRD, thermal analysis, UV-Vis and fluorescence spectroscopy, fluorescence microscopy, zeta potential and dielectric analysis. The MTT viability test was applied to check the cytotoxicity of the obtained membranes, while the microbiological assessment was performed against strains of Staphylococcus spp. and Streptococcus spp. The spectrophotometric investigations allowed to follow up the release profile from the HA matrix for MEL, MZ, and T present in the topical treatment considered. We studied the behavior of the active compounds against the pH of the generated environment, and the release profile of the bioactive formulation based on the specific comportment towards pH variation. The controlled delivery of the bioactive compounds using HA as a supportive matrix was modeled applying Korsmeyer–Peppas, Higuchi, first-order kinetic models, and a newly proposed pseudo-first-order kinetic model. (3) Results: It was observed that MZ and T were released at higher active concentrations than MEL when the pH was increased from 6.75, specific for patients with periodontitis, to a pH of 7.10, characterizing the healthy patients. Additionally, it was shown that for MZ, there is a burst delivery up to 2.40 × 10−5 mol/L followed by a release decrease, while for MEL and T a short release plateau was recorded up to a concentration of 1.80 × 10−5 mol/L for MEL and 0.90 × 10−5 mol/L for T, followed by a continuous release; (4) Conclusions: The results are encouraging for the usage of the HA membrane matrix as releasing vehicle for the active components of the proposed topical treatment at a physiological pH.
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Affiliation(s)
- Eugenia Eftimie Totu
- Department of Analytical Chemistry and Environmental Engineering, University Politehnica of Bucharest, 1–7 Polizu St., 011061 Bucharest, Romania
- Correspondence: (E.E.T.); (D.M.)
| | - Daniela Mănuc
- Department of Public Health, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania
- Correspondence: (E.E.T.); (D.M.)
| | - Tiberiu Totu
- School of Life Sciences, Ecole Polytechnique Fédèrale de Lausanne (EPFL), Route Cantonale, 1015 Lausanne, Switzerland; (T.T.); (R.-M.B.)
| | - Corina Marilena Cristache
- Department of Dental Techniques, Faculty of Midwifery and Nursing (FMAM), “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania;
| | - Roxana-Mădălina Buga
- School of Life Sciences, Ecole Polytechnique Fédèrale de Lausanne (EPFL), Route Cantonale, 1015 Lausanne, Switzerland; (T.T.); (R.-M.B.)
| | - Fatih Erci
- Department of Biotechnology, Faculty of Science, Necmettin Erbakan University, Yeni Meram Boulevard Kasim Halife Street, Meram, Konya 42090, Turkey;
| | - Camelia Cristea
- Biotechnologies Center, University of Agriculture and Veterinary Medicine, 42 Blvd. Mărăşti, 011464 Bucharest, Romania;
| | - Ibrahim Isildak
- Department of Bioengineering, Yildiz Campus Barbaros Bulvari, Yildiz Technical University, Istanbul 34343, Turkey;
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Yang Y, Lockwood A. Topical ocular drug delivery systems: Innovations for an unmet need. Exp Eye Res 2022; 218:109006. [DOI: 10.1016/j.exer.2022.109006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/06/2022] [Accepted: 02/20/2022] [Indexed: 02/07/2023]
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Pereira-da-Mota AF, Phan CM, Concheiro A, Jones L, Alvarez-Lorenzo C. Testing drug release from medicated contact lenses: The missing link to predict in vivo performance. J Control Release 2022; 343:672-702. [DOI: 10.1016/j.jconrel.2022.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 12/13/2022]
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Controlled brimonidine release from nanostructured lipid carriers-laden silicone contact lens to treat glaucoma. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Karamitsos A, Lamprogiannis L, Karagkiozaki V, Koutsogianni A, Chakim Z, Ziakas NG, Tsinopoulos I, Logothetidis S. Morphological Characteristics of Drug-Eluting Biodegradable Polymeric Thin Films Developed on the Surface of Intraocular Lenses by Three Techniques: A Comparative Study. Cureus 2021; 13:e19674. [PMID: 34976462 PMCID: PMC8683073 DOI: 10.7759/cureus.19674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/22/2022] Open
Abstract
Background Cataract surgery is a very popular operation that requires a postoperative period of frequent instillation of antibiotic and anti-inflammatory eye drops. Modified drug-eluting intraocular lenses (IOLs) may eliminate the need for eye drops after surgery. Aim The purpose of this study is to compare the morphological characteristics of dexamethasone eluting biodegradable polymeric thin films developed on the surface of commercially available IOLs by three different methods. Method This experimental study was conducted between May and August of 2021 in the Lab for Thin Films - Nanobiomaterials - Nanosystems & Nanometrology (LTFN) of the Aristotle University of Thessaloniki. A mixture of two organic polymers [Poly (D, L-lactide-co-glycolide)(PLGA), lactide: glycolide (75:25) and Polycaprolactone (PCL)] and dexamethasone was prepared and then deposited on the surface of three-piece IOLs by spin coating, by spray coating, and by gravure printing. The modified IOLs were sterilized with the use of ultraviolet (UV) radiation and plasma treatment. Their structural properties were studied with the use of atomic force microscopy (AFM). Results Spin coating and gravure printing produced uniform thin films on the surface of the IOLs which were not damaged during the sterilization process. Spray coating led to the partial coating of the surface of the IOLs; the thin films underwent alterations following plasma treatment. Conclusions Thin films developed by spin coating and gravure printing on IOLs demonstrate the desired morphological characteristics that make them suitable candidates for further research.
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Toffoletto N, Salema-Oom M, Anguiano Igea S, Alvarez-Lorenzo C, Saramago B, Serro AP. Drug-Loaded Hydrogels for Intraocular Lenses with Prophylactic Action against Pseudophakic Cystoid Macular Edema. Pharmaceutics 2021; 13:976. [PMID: 34203367 PMCID: PMC8309109 DOI: 10.3390/pharmaceutics13070976] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 01/19/2023] Open
Abstract
Pseudophakic cystoid macular edema (PCME), caused by chronic inflammation, is the most common cause of visual impairment in the medium-term after cataract surgery. Therefore, the prophylactic topical administration of combined steroidal and non-steroidal anti-inflammatory drugs is commonly done. Drug-eluting intraocular lenses (IOLs) gained interest as an efficient way to overcome the compliance issues related to the use of ocular drops without the need for additional surgical steps. The incorporation of functional monomers and molecular imprinting were herein applied to design hydrogels suitable as IOLs and able to co-deliver steroidal (dexamethasone sodium phosphate) and non-steroidal (bromfenac sodium) drugs. The incorporation of N-(2-aminopropyl) methacrylamide (APMA) increased the drug uptake and improved the in vitro release kinetics. Imprinting with bromfenac resulted in a decreased drug release due to permanent drug bonding, while imprinting with dexamethasone increased the amount of dexamethasone released after dual-drug loading. The application of a mathematical model to predict the in vivo drug release behavior suggests the feasibility of achieving therapeutic drug concentrations of bromfenac and dexamethasone in the aqueous humor for about 2 and 8 weeks, respectively, which is compatible with the current topical prophylaxis after cataract surgery.
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Affiliation(s)
- Nadia Toffoletto
- Centro de Química Estrutural, Instituto Superior Técnico, University of Lisbon, Avenue Rovisco Pais, 1049-001 Lisbon, Portugal; (B.S.); (A.P.S.)
| | - Madalena Salema-Oom
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal;
| | - Soledad Anguiano Igea
- HGBeyond Materials Science S.L., Edificio EMPRENDIA, 15782 Santiago de Compostela, Spain;
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I + D Farma (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain;
| | - Benilde Saramago
- Centro de Química Estrutural, Instituto Superior Técnico, University of Lisbon, Avenue Rovisco Pais, 1049-001 Lisbon, Portugal; (B.S.); (A.P.S.)
| | - Ana Paula Serro
- Centro de Química Estrutural, Instituto Superior Técnico, University of Lisbon, Avenue Rovisco Pais, 1049-001 Lisbon, Portugal; (B.S.); (A.P.S.)
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal;
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Toffoletto N, Chauhan A, Alvarez-Lorenzo C, Saramago B, Serro AP. Asymmetry in Drug Permeability through the Cornea. Pharmaceutics 2021; 13:694. [PMID: 34064834 PMCID: PMC8151369 DOI: 10.3390/pharmaceutics13050694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/14/2022] Open
Abstract
The permeability through the cornea determines the ability of a drug or any topically applied compound to cross the tissue and reach the intraocular area. Most of the permeability values found in the literature are obtained considering topical drug formulations, and therefore, refer to the drug permeability inward the eye. However, due to the asymmetry of the corneal tissue, outward drug permeability constitutes a more meaningful parameter when dealing with intraocular drug-delivery systems (i.e., drug-loaded intraocular lenses, intraocular implants or injections). Herein, the permeability coefficients of two commonly administered anti-inflammatory drugs (i.e., bromfenac sodium and dexamethasone sodium) were determined ex vivo using Franz diffusion cells and porcine corneas in both inward and outward configurations. A significantly higher drug accumulation in the cornea was detected in the outward direction, which is consistent with the different characteristics of the corneal layers. Coherently, a higher permeability coefficient was obtained for bromfenac sodium in the outward direction, but no differences were detected for dexamethasone sodium in the two directions. Drug accumulation in the cornea can prolong the therapeutic effect of intraocular drug-release systems.
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Affiliation(s)
- Nadia Toffoletto
- Centro de Química Estrutural, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais, 1049-001 Lisbon, Portugal; (B.S.); (A.P.S.)
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal
| | - Anuj Chauhan
- Department of Chemical Engineering, Colorado School of Mines, Golden, CO 80401, USA;
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain;
| | - Benilde Saramago
- Centro de Química Estrutural, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais, 1049-001 Lisbon, Portugal; (B.S.); (A.P.S.)
| | - Ana Paula Serro
- Centro de Química Estrutural, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais, 1049-001 Lisbon, Portugal; (B.S.); (A.P.S.)
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal
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Chirila TV. Oxygen Permeability of Silk Fibroin Hydrogels and Their Use as Materials for Contact Lenses: A Purposeful Analysis. Gels 2021; 7:gels7020058. [PMID: 34064586 PMCID: PMC8162346 DOI: 10.3390/gels7020058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 04/24/2021] [Accepted: 05/02/2021] [Indexed: 11/28/2022] Open
Abstract
Fibroin is a fibrous protein that can be conveniently isolated from the silk cocoons produced by the larvae of Bombyx mori silk moth. In its form as a hydrogel, Bombyx mori silk fibroin (BMSF) has been employed in a variety of biomedical applications. When used as substrates for biomaterial-cells constructs in tissue engineering, the oxygen transport characteristics of the BMSF membranes have proved so far to be adequate. However, over the past three decades the BMSF hydrogels have been proposed episodically as materials for the manufacture of contact lenses, an application that depends on substantially elevated oxygen permeability. This review will show that the literature published on the oxygen permeability of BMSF is both limited and controversial. Additionally, there is no evidence that contact lenses made from BMSF have ever reached commercialization. The existing literature is discussed critically, leading to the conclusion that BMSF hydrogels are unsuitable as materials for contact lenses, while also attempting to explain the scarcity of data regarding the oxygen permeability of BMSF. To the author’s knowledge, this review covers all publications related to the topic.
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Affiliation(s)
- Traian V. Chirila
- Queensland Eye Institute, South Brisbane, QLD 4101, Australia; ; Tel.: +61-(0)7-3239-5024
- School of Chemistry & Physics, Queensland University of Technology, Brisbane, QLD 4001, Australia
- Australian Institute of Bioengineering & Nanotechnology (AIBN), The University of Queensland, St Lucia, QLD 4072, Australia
- Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
- School of Molecular Science, The University of Western Australia, Crawley, WA 6009, Australia
- Faculty of Medicine, George E. Palade University of Medicine, Pharmacy, Science & Technology, Târgu Mureş 540139, Romania
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Antimicrobial nanomedicine for ocular bacterial and fungal infection. Drug Deliv Transl Res 2021; 11:1352-1375. [PMID: 33840082 DOI: 10.1007/s13346-021-00966-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 12/13/2022]
Abstract
Ocular infection induced by bacteria and fungi is a major cause of visual impairment and blindness. Topical administration of antibiotics remains the first-line treatment, as effective eradication of pathogens is the core of the anti-infection strategy. Whereas, eye drops lack efficiency and have relatively low bioavailability. Intraocular injection may cause concurrent ocular damage and secondary infection. In addition, antibiotic-based management can be limited by the low sensitivity to multidrug-resistant bacteria. Nanomedicine is proposed as a prospective, effective, and noninvasive platform to mediate ocular delivery and combat pathogen or even resistant strains. Nanomedicine can not only carry antimicrobial agents to fight against pathogens but also directly active microbicidal capability, killing pathogens. More importantly, by modification, nanomedicine can achieve enhanced residence time and release time on the cornea, and easy penetration through corneal tissues into anterior and posterior segments of the eye, thus improving the therapeutic effect for ocular infection. In this review, several categories of antimicrobial nanomedicine are systematically discussed, where the efficiency and possibility of further embellishment and improvement to adapt to clinical use are also investigated. All in all, novel antimicrobial nanomedicine provides potent and prospective ways to manage severe and refractory ocular infections.
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Tapply I, Broadway DC. Improving Adherence to Topical Medication in Patients with Glaucoma. Patient Prefer Adherence 2021; 15:1477-1489. [PMID: 34239297 PMCID: PMC8259615 DOI: 10.2147/ppa.s264926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/02/2021] [Indexed: 12/11/2022] Open
Abstract
The glaucomas form a heterogenous group of conditions, which collectively account for one of the most common irreversible causes of blindness worldwide. The only treatment, for which there is evidence, to stop or slow glaucomatous disease progression is to lower intraocular pressure (IOP); this is most often initially achieved with topical medication. Adherence to anti-glaucoma therapy is known to be low even when compared with adherence to therapy for other chronic conditions. We performed a PubMed search to review evidence as to how adherence to and persistence with anti-glaucoma medications might be improved. Approaches to improving adherence include technological (such as using smart drop bottles or automated reminders) use of instillation aids, improving communication with patient education and improving tolerability of eye drop formulations. There is limited short-term evidence that automated reminders can be effective and, unfortunately, instillation aids have not proved to be efficacious with respect to improving adherence. A range of factors have been identified which affect adherence and persistence, although only a multi-faceted approach has proven evidence of efficacy, compared to improved patient education alone. There is now a wider range of available preservative-free eye drops, which have been shown to be non-inferior in achieving IOP control, with fewer side effects and improved short-term adherence. Further studies relating to adherence are warranted, particularly given the projected increase in glaucoma prevalence worldwide.
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Affiliation(s)
- Ian Tapply
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, NR4 7UY, UK
- Department of Ophthalmology, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
- Correspondence: Ian Tapply Department of Ophthalmology, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, UKTel +44 7810 583319 Email
| | - David C Broadway
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, NR4 7UY, UK
- School of Pharmacy, University of East Anglia, Norwich, NR4 7TJ, UK
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