Objectives Echinocandins are the newest addition of the last decade to the antifungal armamentarium, which, owing to their unique mechanism of action, selectively target the fungal cells without affecting mammalian cells. Since the time of their introduction, they have come to occupy an important niche in the antifungal pharmacotherapy, due to their efficacy, safety, tolerability and favourable pharmacokinetic profiles. This review deals with the varying facets of echinocandins such as their chemistry, in-vitro and in-vivo evaluations, clinical utility and indications, pharmacokinetic and pharmacodynamic profiles, and pharmacoeconomic considerations.Key findings Clinical studies have demonstrated that the echinocandins -caspofungin, micafungin and anidulafungin -are equivalent, if not superior, to the mainstay antifungal therapies involving amphotericin B and fluconazole. Moreover, echinocandin regimen has been shown to be more cost-effective and economical. Hence, the echinocandins have found favour in the management of invasive systemic fungal infections. Conclusions The subtle differences in echinocandins with respect to their pharmacology, clinical therapy and the mechanisms of resistance are emerging at a rapid pace from the current pool of research which could potentially aid in extending their utility in the fungal infections of the eye, heart and nervous system.

Fungal infections of the eye, especially fungal keratitis and endophthalmitis, are major causes of concern and if left untreated could lead to vision loss. Currently, natamycin (polyene antifungal) is the only commercially available topical agent used for the treatment of ocular fungal infections. The other antifungals, belonging to the polyene and azole classes, are used off-label in treating ocular infections and are administered topically, orally, intraocularly, or systemically. Even though their use through the different routes of administration has shown favorable outcomes, challenges such as poor ocular penetration, low bioavailability, ocular toxicity, and systemic side effects limit their utility. Hence, in search of alternative strategies, the echinocandin class of antifungals are currently being assessed for their use in ocular infections. Their evaluation in the ophthalmic arena has been propelled by their efficacy, safety, and tolerability reports in the treatment of systemic invasive fungal infections. This review compiles the reports on the ocular investigations of the 3 commercially available echinocandins-caspofungin, micafungin, and anidulafungin-to understand their potential as ocular antifungal agents.

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Polyenes and azoles constitute 2 major drug classes in the antifungal armamentarium used to treat fungal infections of the eye such as fungal keratitis, endophthalmitis, conjunctivitis, and blepharitis. These classes of drugs have come to occupy an important niche in ophthalmic antifungal therapy due to their broad spectrum of activity against a variety of filamentous and yeast-like fungi. Natamycin suspension (Natacyn Ò), a polyene antifungal drug, is currently the only US FDA-approved formulation for treating ophthalmic fungal infections, whereas the other polyene and azole antifungals such as amphotericin B, fluconazole, itraconazole, ketoconazole, miconazole, voriconazole, and posaconazole are routinely used off-label in the clinical setting. Despite potent antifungal activity, the clinical utility of these agents in ophthalmic infections has been challenged by their physicochemical properties, the unique ocular anatomy and physiology, selective antifungal activity, ocular and systemic toxicity, emergence of resistance and cross-resistance, and absence of reliable techniques for developing a robust in vitroin vivo correlation. This review discusses the aforementioned challenges and the common approaches undertaken to circumnavigate the difficulties associated with the polyene-and azole-based pharmacotherapy of ophthalmic fungal infections.

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Over the past decade, there has been a rise in the number of clinical cases of moderate to severe anterior segment ocular diseases. Conventional topical ophthalmic formulations have several limitations - to address which, novel drug-delivery systems are needed. Additionally, formidable physiological barriers limit ocular bioavailability through the topical route of application. During the last decade, various nano-scaled ocular drug-delivery strategies have been reported. Some of these exploratory, topical, noninvasive approaches have shown promise in improving penetration into the anterior segment tissues of the eye. In this article, we review the available literature with respect to the safety, efficiency and effectiveness of these nano systems.

The current study sought to formulate, optimize, and evaluate curcumin-loaded Nanostructured Lipid Carriers (NLCs) for their in vitro and ex vivo characteristics. NLCs, prepared using hot-melt emulsification and ultrasonication techniques, were optimized using a Central Composite Design (CCD) and evaluated for their in vitro physicochemical characteristics. Their stability over a 3 month period and transcorneal permeation across excised rabbit corneas (ex vivo) were assessed for the optimized NLCs. The optimized NLC, with a particle size of 66.8 ± 2 nm, polydispersity index of 0.17±0.05, entrapment efficiency of 96 ± 1.6%, and drug loading of 3.1 ± 0.05% w/w, was chosen using CCD. The optimized NLCs showed optimum ex vivo stability at 4°C for the study period and demonstrated a significant increase in curcumin permeation (~2.5-fold) across the rabbit cornea in comparison to the control. Overall, these studies indicated the successful development of NLCs using the design of experiment approach; the formulation enhanced curcumin permeation across excised corneas and did not show any harmful side effects.