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Pawar VU, Dessai AD, Nayak UY. Oleogels: Versatile Novel Semi-Solid System for Pharmaceuticals. AAPS PharmSciTech 2024; 25:146. [PMID: 38937416 DOI: 10.1208/s12249-024-02854-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
Oleogels is a novel semi-solid system, focusing on its composition, formulation, characterization, and diverse pharmaceutical applications. Due to their stability, smoothness, and controlled release qualities, oleogels are frequently utilized in food, cosmetics, and medicinal products. Oleogels are meticulously formulated by combining oleogelators like waxes, fatty acids, ethyl cellulose, and phytosterols with edible oils, leading to a nuanced understanding of their impact on rheological characteristics. They can be characterized by methods like visual inspection, texture analysis, rheological measurements, gelation tests, and microscopy. The applications of oleogels are explored in diverse fields such as nutraceuticals, cosmetics, food, lubricants, and pharmaceutics. Oleogels have applications in topical, transdermal, and ocular drug delivery, showcasing their potential for revolutionizing drug administration. This review aims to enhance the understanding of oleogels, contributing to the evolving landscape of pharmaceutical formulations. Oleogels emerge as a versatile and promising solution, offering substantial potential for innovation in drug delivery and formulation practices.
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Affiliation(s)
- Vaishnavi U Pawar
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Akanksha D Dessai
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Usha Y Nayak
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
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Kivrak U, Arsan AK, Akçay G, Bulut MN, Kanar HS, Hacısalihoğlu AO, Şimşek Ş. Clinical features, management, and outcomes of patients with sterile endophthalmitis associated with intravitreal bevacizumab injection: retrospective case series. Int Ophthalmol 2024; 44:216. [PMID: 38705908 DOI: 10.1007/s10792-024-03134-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 04/11/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To evaluate clinical features, treatment protocol, outcomes, and complications that developed in this case series of 24 patients who had consecutive sterile endophthalmitis after intravitreal bevacizumab (IVB) injection. METHODS In this retrospective case series, IVB was repackaged in individual aliquots from the three batches that were used on the same day. IVB was injected into 26 eyes of 26 patients due to diabetic macular edema, age-related macular degeneration, and branch retinal vein occlusion. All patients had intraocular inflammation. Patients were divided into two groups severe and moderate inflammation according to the intraocular inflammation. The medical records of all patients were reviewed. At each follow-up visit, the complete ophthalmologic examination was performed, including best corrected visual acuity (BCVA), intraocular pressure, biomicroscopy, and posterior fundus examination. RESULTS Twenty-four of 26 patients were included in the study. Two patients were excluded from this study since they didn't come to follow-up visits. The mean BCVA was 1.00 ± 0.52 Log MAR units before IVB. At the final visit, the BCVA was 1.04 ± 0.47 Log MAR units. These differences were not significant (p = 0.58). Of the 24 eyes, 16 eyes had severe, and 8 eyes had moderate intraocular inflammation. Eleven eyes in the severe inflammation group underwent pars plana vitrectomy due to intense vitreous opacity. Smear, culture results, and polymerase chain reaction results were negative. CONCLUSION Sterile endophthalmitis may occur after IVB injection. Differential diagnosis of sterile endophthalmitis from infective endophthalmitis is crucial to adjust the appropriate treatment and prevent long-term complications due to unnecessary treatment.
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Affiliation(s)
- Ulviye Kivrak
- Department of Ophthalmology, University of Health Sciences, Kartal Lütfi Kirdar City Hospital, Kartal Dr. Lütfi Kirdar Egitim ve Arastirma Hastanesi Göz Klinigi, Cevizli, D-100 Güney Yanyol, Cevizli Mevkii No:47, 34865, Istanbul, Turkey.
- Advanced Neurological Sciences, Istanbul University Institute of Graduate Studies in Health Sciences, Istanbul, Turkey.
| | - Aysu Karatay Arsan
- Department of Ophthalmology, University of Health Sciences, Kartal Lütfi Kirdar City Hospital, Kartal Dr. Lütfi Kirdar Egitim ve Arastirma Hastanesi Göz Klinigi, Cevizli, D-100 Güney Yanyol, Cevizli Mevkii No:47, 34865, Istanbul, Turkey
| | - Güzide Akçay
- Department of Ophthalmology, University of Health Sciences, Kartal Lütfi Kirdar City Hospital, Kartal Dr. Lütfi Kirdar Egitim ve Arastirma Hastanesi Göz Klinigi, Cevizli, D-100 Güney Yanyol, Cevizli Mevkii No:47, 34865, Istanbul, Turkey
| | - Muhammed Nurullah Bulut
- Department of Ophthalmology, University of Health Sciences, Kartal Lütfi Kirdar City Hospital, Kartal Dr. Lütfi Kirdar Egitim ve Arastirma Hastanesi Göz Klinigi, Cevizli, D-100 Güney Yanyol, Cevizli Mevkii No:47, 34865, Istanbul, Turkey
| | - Hatice Selen Kanar
- Department of Ophthalmology, University of Health Sciences, Kartal Lütfi Kirdar City Hospital, Kartal Dr. Lütfi Kirdar Egitim ve Arastirma Hastanesi Göz Klinigi, Cevizli, D-100 Güney Yanyol, Cevizli Mevkii No:47, 34865, Istanbul, Turkey
| | - Aynur Oflaz Hacısalihoğlu
- Department of Ophthalmology, University of Health Sciences, Kartal Lütfi Kirdar City Hospital, Kartal Dr. Lütfi Kirdar Egitim ve Arastirma Hastanesi Göz Klinigi, Cevizli, D-100 Güney Yanyol, Cevizli Mevkii No:47, 34865, Istanbul, Turkey
| | - Şaban Şimşek
- Department of Ophthalmology, University of Health Sciences, Kartal Lütfi Kirdar City Hospital, Kartal Dr. Lütfi Kirdar Egitim ve Arastirma Hastanesi Göz Klinigi, Cevizli, D-100 Güney Yanyol, Cevizli Mevkii No:47, 34865, Istanbul, Turkey
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Silva Tavares Neto JED, Cyrino FVR, Lucena MM, Scott IU, Messias AMV, Jorge R. Intravitreal bevacizumab plus propranolol for neovascular age-related macular degeneration (the BEVALOL study): a phase I clinical trial. Int J Retina Vitreous 2023; 9:28. [PMID: 37055868 PMCID: PMC10099020 DOI: 10.1186/s40942-023-00460-1] [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: 02/12/2023] [Accepted: 03/25/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Given the persistently large public health impact of neovascular age-related macular degeneration (nARMD) despite many years of anti-VEGF therapy as the first-line treatment and the demonstrated ability of b-blockers to reduce neovascularization, a synergistic effect between an anti-VEGF agent and an intravitreal beta-blocker is important to investigate in the quest for therapeutic alternatives that maximize efficacy and/or reduce costs. The main purpose of this study is to investigate the safety of a 0.1 ml intravitreal injection of a combination of bevacizumab (1.25 mg/0.05 ml) and propranolol (50 g/0.05 ml) to treat nARMD. METHODS Prospective phase I clinical trial that included patients with nARMD. Comprehensive ophthalmic evaluation was performed at baseline and included Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA), biomicroscopy of the anterior and posterior segments, binocular indirect ophthalmoscopy, color fundus photography, spectral domain optical coherence tomography (OCT), OCT angiography (OCT-A), fluorescein angiography (Spectralis, Heidelberg), and full-field electroretinography (ERG). All eyes were treated with a 0.1 ml intravitreal injection of a combination of bevacizumab (1.25 mg/0.05 ml) and propranolol (50 g/0.05 ml) within 1 week of baseline evaluation. The patients were reexamined at weeks 4, 8 and 12, and clinical evaluation and SD-OCT were performed at all follow-up visits. Additional injections of combination bevacizumab (1.25 mg/0.05 ml) and propranolol (50 g/0.05 ml) were administered at weeks 4 and 8. At the final study evaluation (week 12), color fundus photography, OCT-A, fluorescein angiography, and full-field ERG were repeated. RESULTS Eleven patients (11 eyes) completed all study visits of the 12 week study. Full field ERG b-waves did not show significant (p < 0.05) changes at week 12 compared to baseline. During the 12 week follow-up period, none of the study eyes developed intraocular inflammation, endophthalmitis or intraocular pressure elevation more than 4 mmHg over baseline. Mean ± SE BCVA (logMAR) was 0.79 ± 0.09 at baseline and was significantly (p < 0.05) improved to 0.61 ± 0.10 at week 4; 0.53 ± 0.10 at week 8; and 0.51 ± 0.09 at week 12. Mean ± SE central subfield thickness (CST) (μm) was 462 ± 45 at baseline and was significantly (p < 0.05) lower at 4, 8 and 12 weeks (385 ± 37; 356 ± 29 and 341 ± 24, respectively). CONCLUSIONS In this 12 week trial of a combination of intravitreal bevacizumab and propranolol for treatment of nARMD, no adverse events or signals of ocular toxicity were observed. Further studies using this combination therapy are warranted. Trial Registration Project registered in Plataforma Brasil with CAAE number 28108920.0.0000.5440 and approved in ethics committee of Clinics Hospital of Ribeirao Preto Medicine School of São Paulo University-Ribeirão Preto, São Paulo, Brazil (appreciation number 3.999.989 gave the approval).
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Affiliation(s)
- José Edísio da Silva Tavares Neto
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, 3900, Bandeirantes av., Ribeirão Preto, 14048-900, Brazil
| | - Francyne Veiga Reis Cyrino
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, 3900, Bandeirantes av., Ribeirão Preto, 14048-900, Brazil
| | - Moises Moura Lucena
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, 3900, Bandeirantes av., Ribeirão Preto, 14048-900, Brazil
| | - Ingrid U Scott
- Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - André Márcio Vieira Messias
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, 3900, Bandeirantes av., Ribeirão Preto, 14048-900, Brazil
| | - Rodrigo Jorge
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, 3900, Bandeirantes av., Ribeirão Preto, 14048-900, Brazil.
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Scherbakova I, Ragi SD, Sharma T. Ocular Injection Techniques for Retinitis Pigmentosa: Intravitreal, Subretinal, and Suprachoroidal. Methods Mol Biol 2022; 2560:375-392. [PMID: 36481912 DOI: 10.1007/978-1-0716-2651-1_34] [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: 12/13/2022]
Abstract
Ocular gene therapy represents an emerging and promising therapeutic approach for the treatment of several of the inherited retinal diseases. Currently, the focus has been to investigate monogenic inherited retinal disorders. Genetic and cellular therapies can be delivered to the eye by various injection techniques, including those that are intravitreal, subretinal, and suprachoroidal. Each of these three delivery methods are discussed with regard to their historical background, indications, surgical steps, and follow-up.
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Affiliation(s)
- Ioana Scherbakova
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA.
| | - Sara D Ragi
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Tarun Sharma
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
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Bhatia D, Mehta A, DaCosta J, Crothers O, Talks JS. Real-World Anti-Vascular Endothelial Growth Factor Therapy Outcomes in Myopic Choroidal Neovascularization. Clin Ophthalmol 2021; 15:2753-2758. [PMID: 34211264 PMCID: PMC8240844 DOI: 10.2147/opth.s311816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/27/2021] [Indexed: 12/02/2022] Open
Abstract
Aim Evaluation of real-world outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in the primary treatment of choroidal neovascularization (CNV) secondary to pathological myopia. Patients and Methods A retrospective cohort analysis of treatment naive patients with myopic CNV who received treatment with either intravitreal ranibizumab or aflibercept over a 12-year period from September 2007 to May 2020 was performed. Baseline features, treatment factors and outcomes were compared between younger and older patients and final visual outcome was assessed for associated factors. Results Thirty-seven eyes of 36 patients (24 females, 12 males) were included. Mean age was 58 years (range=26–89 years). Of these patients, 11/36 (31%) were ≤50 years of age and 25/36 (69%) were ≥51 years of age. Seventy-three percent (27/37) of eyes were phakic. One patient received bilateral treatment for myopic CNV. Median spherical equivalent was −8.50 diopters. Seventy percent (26/37) of eyes commenced primary treatment with ranibizumab, and 11/37 (30%) eyes commenced treatment with aflibercept. There were no significant differences between treatment factors and outcomes of younger and older patients. Median number of injections was 3 over a median follow-up period of 24.6 months. Mean CRT decreased by 126μm and median visual improvement was +6 letters. Analysis showed that younger age (p=0.022) and fewer injections (p=0.004) were associated with better visual outcomes. Conclusion Myopic CNV requires less frequent anti-VEGF intravitreal therapy over a shorter follow-up period than both neovascular age-related macular degeneration and diabetic macular edema. Increased frequency of administration of intravitreal anti-VEGF treatment did not improve vision. Younger age is associated with a better final visual outcome. These findings may help to advise patients about the prognosis of treatment and help guide treatment decisions.
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Affiliation(s)
- Devangna Bhatia
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Alexander Mehta
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Joanna DaCosta
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Oonagh Crothers
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Han JY, Lee DH, Kim JD, Choi EY, Kim M. Therapeutic Efficacy of Intravitreal Dexamethasone Implant in Korean Patients with Non-infectious Uveitis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.6.798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Baba T, Miura G, Tatsumi T, Sakurai M, Yamamoto S. Characteristics and surgical outcomes of rhegmatogenous retinal detachments that develop after intravitreal injections. Jpn J Ophthalmol 2021; 65:492-496. [PMID: 33745092 DOI: 10.1007/s10384-021-00834-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/18/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the frequency and characteristics of rhegmatogenous retinal detachments (RRDs) that develop after an intravitreal injection of anti-vascular endothelial growth factor (VEGF) agent. STUDY DESIGN A retrospective review of the medical charts. METHODS The charts of patients who received intravitreal injections for age-related macular degeneration (AMD), diabetic macular edema (DME), retinal vein occlusion (RVO), or myopic choroidal neovascularization (mCNV) between 2013 and 2020 were reviewed. We included the RRD cases that developed within 90 days of the most recent intravitreal injection. The baseline characteristics and surgical outcomes were analyzed. RESULTS A total of 3040 patients received 28,190 intravitreal injections. Seven eyes of 7 cases developed a RRD. There were 6 cases of AMD and one of DME, with an incidence of one in 4027 injections (0.025%). The retinal break was in the superior quadrants in 5 eyes (71%), and in the inferior quadrants in 2 eyes. All eyes had a posterior vitreous detachment. The average number of injections before the development of RRD was 14.1 (range: 2-39). Four eyes were treated by vitrectomy, and 3 by scleral buckling. The primary success rate was 86%, and the final reattachment rate was 100%. The best-corrected visual acuity was 0.41 ± 0.26 logarithm of minimal angle of resolution (logMAR) units before developing the RRD, 0.78 ± 0.78 logMAR units before the surgery for RRD, and 0.45 ± 0.47 logMAR units at the final visit. CONCLUSIONS The incidence of RRD after an intravitreal injection is very low (0.025%), and it can be reattached with recovery of the visual acuity.
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Affiliation(s)
- Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-0856, Japan.
| | - Gen Miura
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-0856, Japan
| | - Tomoaki Tatsumi
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-0856, Japan
| | - Madoka Sakurai
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-0856, Japan
| | - Shuichi Yamamoto
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-0856, Japan
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Kishore K, McGowan DS, Hanebrink KA. Iatrogenic Retinal Penetration from Intravitreal Injections. Case Rep Ophthalmol 2021; 12:248-253. [PMID: 33976691 PMCID: PMC8077486 DOI: 10.1159/000512695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/30/2020] [Indexed: 11/19/2022] Open
Abstract
We present 2 cases of iatrogenic retinal penetration from intravitreal (IVT) injections in a retrospective noncomparative case series of 2 patients. The first patient, an 81-year-old Caucasian male, developed dense vitreous hemorrhage soon after receiving an IVT bevacizumab injection for macular edema from central retinal vein occlusion. A 25-g vitrectomy 1 week later showed a retinal hole surrounded by fresh hemorrhages in the same quadrant as the IVT injection. The second patient, an 87-years-old male, developed a retinal detachment after 28 injections of anti-VEGF medications for neovascular AMD. A peripheral round hole was observed during vitrectomy without any lattice degeneration in the same quadrant as prior IVT injections. Both eyes were pseudophakic, had normal axial lengths, and received injections without measuring the injection site. Retinal penetration from IVT injections can result in serious sight-threatening complications. Measuring the injection site from the limbus should be part of safe IVT injection technique.
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Affiliation(s)
- Kamal Kishore
- Illinois Retina and Eye Associates, Peoria, Illinois, USA
- Department of Surgery, University of Illinois College of Medicine, Peoria, Illinois, USA
| | - Daniel S. McGowan
- Department of Surgery, University of Illinois College of Medicine, Peoria, Illinois, USA
| | - Kurt A. Hanebrink
- Department of Surgery, University of Illinois College of Medicine, Peoria, Illinois, USA
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Nuzbrokh Y, Kassotis AS, Ragi SD, Jauregui R, Tsang SH. Treatment-Emergent Adverse Events in Gene Therapy Trials for Inherited Retinal Diseases: A Narrative Review. Ophthalmol Ther 2020; 9:709-724. [PMID: 32740739 PMCID: PMC7708583 DOI: 10.1007/s40123-020-00287-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Indexed: 12/24/2022] Open
Abstract
Patient safety is a primary priority in the conduction of retinal gene therapy trials. An understanding of risk factors and mitigation strategies for post-procedure complications is crucial for the optimization of gene therapy clinical trial protocols. In this review, we synthesize the literature on ocular delivery methods, vector platforms, and treatment-emergent adverse effects in recent gene therapy clinical trials for inherited retinal diseases.
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Affiliation(s)
- Yan Nuzbrokh
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
- Jonas Children's Vision Care, New York, NY, USA
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Alexis S Kassotis
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Sara D Ragi
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
- Jonas Children's Vision Care, New York, NY, USA
| | - Ruben Jauregui
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
- Jonas Children's Vision Care, New York, NY, USA
| | - Stephen H Tsang
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA.
- Jonas Children's Vision Care, New York, NY, USA.
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA.
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Ibeanu N, Egbu R, Onyekuru L, Javaheri H, Tee Khaw P, R. Williams G, Brocchini S, Awwad S. Injectables and Depots to Prolong Drug Action of Proteins and Peptides. Pharmaceutics 2020; 12:E999. [PMID: 33096803 PMCID: PMC7589296 DOI: 10.3390/pharmaceutics12100999] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/29/2020] [Accepted: 10/12/2020] [Indexed: 12/30/2022] Open
Abstract
Proteins and peptides have emerged in recent years to treat a wide range of multifaceted diseases such as cancer, diabetes and inflammation. The emergence of polypeptides has yielded advancements in the fields of biopharmaceutical production and formulation. Polypeptides often display poor pharmacokinetics, limited permeability across biological barriers, suboptimal biodistribution, and some proclivity for immunogenicity. Frequent administration of polypeptides is generally required to maintain adequate therapeutic levels, which can limit efficacy and compliance while increasing adverse reactions. Many strategies to increase the duration of action of therapeutic polypeptides have been described with many clinical products having been developed. This review describes approaches to optimise polypeptide delivery organised by the commonly used routes of administration. Future innovations in formulation may hold the key to the continued successful development of proteins and peptides with optimal clinical properties.
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Affiliation(s)
- Nkiruka Ibeanu
- School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK; (N.I.); (R.E.); (L.O.); (H.J.); (G.R.W.); (S.B.)
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 9EL, UK;
| | - Raphael Egbu
- School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK; (N.I.); (R.E.); (L.O.); (H.J.); (G.R.W.); (S.B.)
| | - Lesley Onyekuru
- School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK; (N.I.); (R.E.); (L.O.); (H.J.); (G.R.W.); (S.B.)
| | - Hoda Javaheri
- School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK; (N.I.); (R.E.); (L.O.); (H.J.); (G.R.W.); (S.B.)
| | - Peng Tee Khaw
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 9EL, UK;
| | - Gareth R. Williams
- School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK; (N.I.); (R.E.); (L.O.); (H.J.); (G.R.W.); (S.B.)
| | - Steve Brocchini
- School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK; (N.I.); (R.E.); (L.O.); (H.J.); (G.R.W.); (S.B.)
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 9EL, UK;
| | - Sahar Awwad
- School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK; (N.I.); (R.E.); (L.O.); (H.J.); (G.R.W.); (S.B.)
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London EC1V 9EL, UK;
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Karasu B. Short-term outcomes of subtenon triamcinolone acetonide injections in patients with retinitis pigmentosa-associated cystoid macular edema unresponsive to carbonic anhydrase inhibitors. Int Ophthalmol 2019; 40:677-687. [PMID: 31773389 DOI: 10.1007/s10792-019-01228-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/15/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the functional and anatomical results of subtenon triamcinolone acetonide injection (TA) in eyes with retinitis pigmentosa (RP) that had cystoid macular edema (CME) unresponsive to carbonic anhydrase inhibitors (CAIs). MATERIALS AND METHODS This is a prospective, interventional study. Forty-eight consecutive eyes that underwent subtenon TA for CME due to RP were recorded. Central macular thickness (CMT), best-corrected visual acuities (BCVAs) and intraocular pressures (IOPs) were evaluated before and after injection at 2nd week, 1st month, 2nd month and 3rd month, respectively. Spectral-domain optical coherence tomography (SD-OCT) was used to show anatomic findings. Complications such as cataract and glaucoma were recorded. RESULTS A total of 48 eyes of 42 patients with a mean age of 36.25 ± 15.59 years (range 13 to 63 years) and a mean follow-up of 4.45 ± 0.74 months (range 4 to 6 months) were recorded in the study. The mean initial BCVA increased from 1.09 ± 0.52 to 0.54 ± 0.29 logarithmic minimum angle of resolution (log MAR) (p < 0.001) at 3 months after injection and the mean central macular thickness decreased from 591.45 ± 209.55 µm to 270.83 ± 95.48 µm (p < 0.001). The mean iOP increased from 13.58 ± 2.87 mmHg to 15.91 ± 2.47 mmHg (p < 0.001). Multiple injections (3 injections) in 1 eye, 2 injections in 4 eyes and 1 injection in rest of the eyes were performed at 3-month intervals. Complications such as glaucoma and cataract were not observed in any patient during and after the treatment. CONCLUSION In the present study, a significant improvement in visual acuity and CMT were observed in eyes with subtenon TA for CME due to RP unresponsive to CAIS. Further studies with a long follow-up period of the population are required to investigate the role of subtenon TA of CME due to RP.
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Affiliation(s)
- Buğra Karasu
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Bereketzade Mah, Bereketzade Sok. No:2, Beyoğlu, 34421, Istanbul, Turkey.
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Macoon R, Guerriero T, Chauhan A. Extended release of dexamethasone from oleogel based rods. J Colloid Interface Sci 2019; 555:331-341. [PMID: 31394320 PMCID: PMC6764860 DOI: 10.1016/j.jcis.2019.07.082] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/26/2019] [Accepted: 07/27/2019] [Indexed: 12/18/2022]
Abstract
HYPOTHESIS Topical and systemic methods are not able to deliver ophthalmic drugs for treatment of retinal diseases. Consequently, invasive monthly intravitreal injections through the eyeball are required to deliver retinal drugs. A reduction in the frequency of the injection through extended release of the drugs could have significant clinical benefits. EXPERIMENTS Oleogels containing ethyl cellulose as the gelator at 10% (wt%) in soybean oil were loaded with dexamethasone above the solubility limit and expunged from a syringe to create cylindrical rods for extended drug delivery. The devices were imaged to explore particle distribution and drug release was measured under sink conditions in buffer. A model was developed and fitted to data to determine effective drug diffusivity. FINDINGS Dexamethasone is released slowly due to the presence of the drug particles that serve as drug depots. The release increases from 600 to 3000 h as the drug loading is increased from 3% to 28%. The release profiles can be modeled by considering drug dissolution and diffusion, as well as the tortuosity of the matrix due to the presence of the voids formed after the drug particles have dissolved. The proposed approach is promising as the release profiles of the drug are comparable to commercial devices.
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Affiliation(s)
- Russell Macoon
- Department of Chemical Engineering, University of Florida, Gainesville, FL 32611, United States.
| | - Timothy Guerriero
- Department of Chemical Engineering, University of Florida, Gainesville, FL 32611, United States.
| | - Anuj Chauhan
- Department of Chemical Engineering, Colorado School of Mines, Golden, CO 80401, United States.
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Chaturvedi R, Wannamaker KW, Riviere PJ, Khanani AM, Wykoff CC, Chao DL. Real-World Trends in Intravitreal Injection Practices among American Retina Specialists. Ophthalmol Retina 2019; 3:656-662. [PMID: 31133544 PMCID: PMC6684447 DOI: 10.1016/j.oret.2019.03.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/23/2019] [Accepted: 03/25/2019] [Indexed: 04/25/2023]
Abstract
PURPOSE To analyze practice patterns used for intravitreal injections (IVIs) by retinal specialists in the United States. DESIGN Cross-sectional online survey. PARTICIPANTS Retina specialists in the United States who responded to a web-based survey. METHODS Retinal specialists in the United States were contacted via e-mail to complete a web-based, anonymous, 24-question survey. Multivariate analysis was performed on a selected question of interest focused on choice of anesthetic used for IVI. MAIN OUTCOME MEASURES Differences in IVI practices, such as antibiotic preferences, and different odds of anesthetic use by demographic variables with 95% confidence intervals. RESULTS A total of 281 retinal specialists responded to the survey (17% response rate). Respondents' average age was 53 years, with an average of 20 years in practice. Respondents practiced in 42 states, with 90% practicing in an urban or suburban area. For anesthesia, 14% used a topical anesthetic with cotton swab compression, 27% used a subconjunctival anesthetic, and 31% used an anesthetic gel. Age, gender, geographic location, and practice setting did not seem to impact choice of anesthetic for IVI significantly. Sixty-six percent of respondents always use a lid speculum, 21% administer topical antibiotics before injection, 36% wear a mask, 73% wear gloves, and 45% always dilate the eyes before injection. Most respondents use a 30-gauge needle and inject in the inferior temporal quadrant (70%). Forty-five percent always perform bilateral injections the same day if indicated. After the injection, 14% administer post operative nonsteroidal anti-inflammatory drugs, 28% administer postoperative antibiotics, and 31% routinely check intraocular pressure after injection. CONCLUSIONS This study provided real-world trends in practices for IVI among retina specialists in the United States. In addition, age, gender, practice type, and geographic location did not influence anesthetic choice for IVI.
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Affiliation(s)
- Rahul Chaturvedi
- School of Medicine, University of California, San Diego, La Jolla, California
| | | | - Paul J Riviere
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | | | - Charles C Wykoff
- Retina Consultants of Houston, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Daniel L Chao
- Andrew Viterbi Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, La Jolla, California.
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Terauchi G, Shinoda K, Sakai H, Kawashima M, Matsumoto CS, Mizota A, Miyake Y. Retinal function determined by flicker ERGs before and soon after intravitreal injection of anti-VEGF agents. BMC Ophthalmol 2019; 19:129. [PMID: 31208350 PMCID: PMC6580612 DOI: 10.1186/s12886-019-1129-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/20/2019] [Indexed: 11/26/2022] Open
Abstract
Background To evaluate the retinal function before and soon after an intravitreal injection of an anti-vascular endothelial growth factor (anti-VEGF) agents. Methods Seventy-nine eyes of 79 patients that were treated by an intravitreal injection of an anti-VEGF agent for age-related macular degeneration (AMD), diabetic macular edema (DME), or retinal vein occlusion (RVO) with macular edema (ME) were studied. The RETeval® system was used to record 28 Hz flicker electroretinograms (ERGs) from the injected and non-injected eyes before (Phase 1, P1), within 2 h after the injection (P2), and 2 to 24 h after the injection (P3). Patients were grouped by disease or by the injected agent and compared. The significance of the changes in the implicit times and amplitudes was determined by t tests. Results The amplitudes were not significantly different at the three phases. The implicit time of the injected eye was 31.2 ± 3.2 msec at P1, and it was not significantly different at P2 (31.7 ± 3.1 msec) but it was significantly longer at P3 (32.2 ± 3.3 msec, P < 0.01, ANOVA for both). The implicit time in the non-injected fellow eye was 30.5 ± 3.3 msec at P1, and it was significantly longer at P2 (31.1 ± 3.2 msec) and phase 3 (31.3 ± 3.4 msec, P < 0.01, ANOVA for both). Conclusions The results indicate that an intravitreal anti-VEGF injection will increase the implicit times not only in the injected eye but also in the non-injected eye soon after the intravitreal injection.
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Affiliation(s)
- Gaku Terauchi
- Department of Ophthalmology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Kei Shinoda
- Department of Ophthalmology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan. .,Department of Ophthalmology, Saitama Medical University Faculty of Medicine, 38 Moro-hongo, Moroyama, Iruma-gun, Saitama, 350-0495, Japan.
| | - Hiroyuki Sakai
- Department of Ophthalmology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Makoto Kawashima
- Department of Ophthalmology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Celso Soiti Matsumoto
- Department of Ophthalmology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.,Matsumoto Eye Clinic, 50-2 Takagaki, Awa-cho, Awa-shi, Tokushima, 771-1705, Japan
| | - Atsushi Mizota
- Department of Ophthalmology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Yozo Miyake
- Department of Ophthalmology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
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Abstract
Light and optical techniques have made profound impacts on modern
medicine, with numerous lasers and optical devices being currently used in
clinical practice to assess health and treat disease. Recent advances in
biomedical optics have enabled increasingly sophisticated technologies —
in particular those that integrate photonics with nanotechnology, biomaterials
and genetic engineering. In this Review, we revisit the fundamentals of
light–matter interactions, describe the applications of light in
imaging, diagnosis, therapy and surgery, overview their clinical use, and
discuss the promise of emerging light-based technologies.
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Affiliation(s)
- Seok Hyun Yun
- Wellman Center for Photomedicine, Massachusetts General Hospital, 65 Landsdowne Street, Cambridge, MA 02139, USA.,Department of Dermatology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115.,Harvard-MIT Health Sciences and Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
| | - Sheldon J J Kwok
- Wellman Center for Photomedicine, Massachusetts General Hospital, 65 Landsdowne Street, Cambridge, MA 02139, USA.,Harvard-MIT Health Sciences and Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
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