Intravitreal injections: A review of pharmacological agents and techniques

Shikari, Hasanain; Samant, Preetam

doi:10.4103/2320-3897.174429

Cited by 14 publications

(9 citation statements)

References 99 publications

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“…As can be seen in Table 2, some important differences are shown between the parameters affecting the anterior and posterior elimination route of drugs from the vitreous humor. Several reviews about the development of drug delivery systems have been published previously [71][72][73][74]. For this reason, in this article is not going to be treated in depth.…”

Section: Posterior Routementioning

confidence: 99%

Drug Delivery to the Posterior Segment of the Eye: Biopharmaceutic and Pharmacokinetic Considerations

et al. 2020

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The treatment of the posterior-segment ocular diseases, such as age-related eye diseases (AMD) or diabetic retinopathy (DR), present a challenge for ophthalmologists due to the complex anatomy and physiology of the eye. This specialized organ is composed of various static and dynamic barriers that restrict drug delivery into the target site of action. Despite numerous efforts, effective intraocular drug delivery remains unresolved and, therefore, it is highly desirable to improve the current treatments of diseases affecting the posterior cavity. This review article gives an overview of pharmacokinetic and biopharmaceutics aspects for the most commonly-used ocular administration routes (intravitreal, topical, systemic, and periocular), including information of the absorption, distribution, and elimination, as well as the benefits and limitations of each one. This article also encompasses different conventional and novel drug delivery systems designed and developed to improve drug pharmacokinetics intended for the posterior ocular segment treatment.

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Section: Posterior Routementioning

confidence: 99%

Drug Delivery to the Posterior Segment of the Eye: Biopharmaceutic and Pharmacokinetic Considerations

et al. 2020

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“…The IVI technique has become the most commonly utilized drug delivery route in the treatment of different eye diseases including intraocular inflammation, retinoblastoma and a variety of neovascular disorders of the anterior and posterior eye segments. 1 , 2 , 6–9 , 45 The number of diseases which can be treated with different pharmaceutical agents delivered intravitreally is constantly growing, as well as the number of patients who receive IVIs. Despite the low rate of vision-threatening complications, the actual number of patients experiencing complications caused by IVIs appears to be increasing.…”

Section: Discussionmentioning

confidence: 99%

“… 5–8 Furthermore, IVI of antibiotics, steroids, antiviral, antifungal and cytostatic agents is very important in the treatment of infectious eye diseases of different origin. 6–9 In spite of the low risk for serious vision-threatening complications after IVI, the quantity of IVIs is progressively increasing worldwide, hence the number of patients experiencing IVI-associated complications is also increasing. 10 Endophthalmitis is to one of the most dangerous complications following IVI.…”

Section: Introductionmentioning

confidence: 99%

Novel Needle for Intravitreal Drug Delivery: Comparative Study of Needle Tip Aspirates, Injection Stream and Penetration Forces

Lytvynchuk¹,

Petrovski²,

Dam³

et al. 2021

OPTH

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Purpose To study the efficacy of a novel needle for intravitreal injection (IVI) in comparison to the conventional needle under experimental conditions. Methods The newly designed 30-gauge (G) needle (NDN) (EP 18158 542.3, patent pending) with occluded outer orifice and a side port for drug delivery was compared to the conventional standard hypodermic 30 G needle for IVI (SHN). An animal study to obtain needle tip aspirates was performed on 10 albino rat eyes. During IVIs, cellular content, which was cut by the needle tip, was aspirated. Cellular material was studied in regard to cell types and their quantity. The injection stream was studied using trypan blue dye in vitro and pig cadaver eyes. The penetration force was tested on polyurethane Testing Foil Strips PU 04 (Melab, Leonberg, Germany) by applying a velocity of 100 mm/min. The results were analyzed using descriptive statistics, correlation matrices and t -test methods with p <0.05 as statistically significant. Results Cytological analysis of the needle aspirates showed the presence of cellular content in each case. The amount of conjunctival, ciliary body epithelial cells and granulated basophilic protein sediments (sign of cellular damage) in the case of the NDN tips was significantly lower compared to the SHN. The average penetration force of the NDN was 0.791 N, and in the case of the SHN was 0.566 N. The injection stream study revealed a difference in the initial injection phase between the two needle types, although the diffuse filling of the vitreous area which surrounded the needle tip appeared to be similar. Discussion The NDN demonstrated superior performance with regard to a significantly reduced number of cells being captured by the needle tip. Delivery of the injected fluid into the vitreous cavity was comparable. In order to investigate superior properties of the NDN needle design, further studies with improved prototypes would be necessary.

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“…16,17 However, EO can result from various sources of microorganisms attached to areas around the eye such as lids, lashes, tear film, and conjunctiva, or even from air exhaled from the doctor and patient. [17][18][19][20][21] It is recommended that povidine-iodine (PI) at concentrations between 5% and 10% be applied to the IVT injection site right before the injection. 7 It may also be applied to surrounding structures such as eyelids and eyelashes, but application pressures that could cause the release of meibomian material should be avoided.…”

Section: Guidelines For Ivt Injectionsmentioning

confidence: 99%

Intravitreal, Subretinal, and Suprachoroidal Injections: Evolution of Microneedles for Drug Delivery

Hartman

Kompella

2018

Journal of Ocular Pharmacology and Therapeutics

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Even though the very thought of an injection into the eye may be frightening, an estimated 6 million intravitreal (IVT) injections were made in the USA during 2016. With the introduction of new therapeutic agents, this number is expected to increase. In addition, drug products that are injectable in ocular compartments other than the vitreous humor are expected to enter the back of the eye market in the not so distant future. Besides the IVT route, some of the most actively investigated routes of invasive administration to the eye include periocular, subretinal, and suprachoroidal (SC) routes. While clinical efficacy is the driving force behind new injectable drug product development for the eye, safety is also being improved with time. In the case of IVT injections, the procedural guidelines have evolved over the years to improve patient comfort and reduce injection-related injury and infection. Similar advances are anticipated for other routes of administration of injectable products to the eye. In addition to procedural improvements, the design of needles, particularly those with smaller diameters, length, and controlled bevel angles are expected to improve overall safety and acceptance of injected ophthalmic drug products. A key development in this area is the introduction of microneedles of a length less than a millimeter that can target the SC space. In the future, needles with smaller diameters and lengths, potentially approaching nanodimensions, are expected to revolutionize ophthalmic disease management.

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Intravitreal injections: A review of pharmacological agents and techniques

Cited by 14 publications

References 99 publications

Drug Delivery to the Posterior Segment of the Eye: Biopharmaceutic and Pharmacokinetic Considerations

Drug Delivery to the Posterior Segment of the Eye: Biopharmaceutic and Pharmacokinetic Considerations

Novel Needle for Intravitreal Drug Delivery: Comparative Study of Needle Tip Aspirates, Injection Stream and Penetration Forces

Intravitreal, Subretinal, and Suprachoroidal Injections: Evolution of Microneedles for Drug Delivery

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