A Review of Ocular Drug Delivery Platforms and Drugs for Infectious and Noninfectious Uveitis: The Past, Present, and Future

Abstract

Uveitis refers to a broad group of inflammatory disorders of the eye that often require medical and surgical management to improve or stabilize vision and prevent vision-threatening pathological changes to the eye. Drug delivery to the eye to combat inflammation and subsequent complications from uveitic conditions is complex as there are multiple barriers to absorption limiting availability of the needed drug in the affected tissues. As such, there has been substantial interest in developing new drugs and drug delivery platforms to help reduce intraocular inflammation and its complications. In this review, we discuss the challenges of drug delivery, novel technologies recently approved for uveitis patient care and promising drug delivery platforms for uveitis and sequelae of ocular inflammation.

Microinjection via the suprachoroidal space: a review of a novel mode of administration

“…Standard methods include systemic delivery (eg, oral, intravenous, and subcutaneous routes) as well as local drug delivery methods (eg, topical eye drops, periocular or intravitreal [IVT] injections, and IVT implants) (Figure 1). 2 Systemic delivery of drugs for ocular conditions can result in systemic AEs, such as gastrointestinal (GI) issues. 1,2 Furthermore, local delivery methods may be limited by the occurrence of AEs associated with drug exposure to unaffected tissue and, in some cases, by the inability of drugs to penetrate the cornea or sclera or into the posterior segment when delivered via a topical or periocular route.…”

“…Standard ocular drug delivery methods may involve systemic treatment, topical application, and delivery adjacent to the eye (periocular) or into the vitreous humor. 1,2 Systemic therapy may be associated with adverse effects (AEs) due to systemic drug exposure, whereas local therapy can be limited by drug exposure to unaffected ocular tissues and by variable or low concentrations of the therapy delivered to target tissues due to the eye's anatomy. [1][2][3][4][5][6] For diseases affecting the posterior tissues of the eye, SCS administration offers compartmentalization of therapies away from anterior tissues and the potential for long-acting delivery to target tissues.…”

“…1,2 Systemic therapy may be associated with adverse effects (AEs) due to systemic drug exposure, whereas local therapy can be limited by drug exposure to unaffected ocular tissues and by variable or low concentrations of the therapy delivered to target tissues due to the eye's anatomy. [1][2][3][4][5][6] For diseases affecting the posterior tissues of the eye, SCS administration offers compartmentalization of therapies away from anterior tissues and the potential for long-acting delivery to target tissues. 7,8 One disease that can affect posterior tissues and that is associated with considerable visual impairment is uveitis, which is characterized by inflammation of the uveal tract (ie, iris, ciliary body, and choroid) and adjacent structures.…”

Cellulosic Polymers for Enhancing Drug Bioavailability in Ocular Drug Delivery Systems

“…Furthermore, the intra-cameral route is used for direct delivery of the drug to the anterior chamber; however, general anesthesia is required before injection. This route may cause damage to intraocular structures such as the iris, lens, and corneal endothelium [25,30].…”

A Review of Systemic Biologics and Local Immunosuppressive Medications in Uveitis

“…Methotrexate was the first systemic non-steroidal IMT that received FDA approval for use in autoimmune disease. [ 147 ] Efficacy of intravitreally administered methotrexate in patients with noninfectious uveitis has been reported in retrospective studies. [ 148 , 149 ] Safety and efficacy of this drug in patients with macular edema is currently under investigation in the Macular Edema Ranibizumab versus Intravitreal Anti-inflammatory Therapy (MERIT) multicenter, randomized controlled.…”