Intravitreal delivery implantable devices

The success of intravitreal implants, such as achieved with ganciclovir, has renewed interest in developing an intravitreal corticosteroid implant to further enhance the intravitreal route of administration, thus reducing the need for multiple injections. Bausch and Lomb and Control Delivery Systems have developed an intravitreal implant that can deliver the corticosteroid fluocinolone acetonide (Retrisert) to posterior eye tissue for up to 3 years. The implant, which was approved in 2005 by the U.S. Food and DrugAdministration (FDA), delivers 0.59 or 2.1 mg of fluocinolone acetonide. The long-term ocular side effects of this device are unknown at this time. 

Sustained delivery of ophthalmic medications is a novel approach in treating chronic intraocular infections in conditions where systemic administration is accompanied by undesirable side-effects and repeated intravitreal injections carry the risk of infection. The administration of medications by implants or depot devices is a very rapidly developing technology in ocular therapeutics. The various types of implant and mechanisms of drug release have been discussed in general in Chapter 4. 

Kato et al. carried out rabbit studies with a scleral implant placed to the posterior pole. The device releases the drug, betamethasone, constantly for at least 3 months without detectable drug concentration in the aqueous humor. Interestingly, the implant showed more effective delivery to the macular region than the intravitreal implants. The episcleral system is a promising means for the treatment of the retinal and choroidal diseases. 

The development of polymeric drug delivery devices for sustained ophthalmic CsA release is an active area of research for uveitis, vitreous inflammation, dry eye, and prevention of cornea transplant rejection. The use of these specialized CsA-delivering ophthalmic systems (e.g., implants nanoparticle and microsphere injections) cannot be completely reviewed in this chapter and readers are referred to an alternative text. A sample of applicable polymers for delivery of CsA for uveitis and vitreous inflammation is offered in the accompanying table (Table 15.4). The treatment of posterior uveitis and vitreous inflammation usually involves chronic therapy (often years) of topical agents and frequent intravitreal injections for disease control. These therapies are often impractical and subject to medical non-adherence [33]. Polymeric implants or injectable polymer sustained release systems can potentially improve patient outcomes through optimized intraocular drug concentrations. 

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