Local delivery of corticosteroids in clinical ophthalmology: A review

Abstract

Locally administered steroids have a long history in ophthalmology for the treatment of inflammatory conditions. Anterior segment conditions tend to be treated with topical steroids whilst posterior segment conditions generally require periocular, intravitreal or systemic administration for penetration. Over recent decades, the clinical applications of periocular steroid delivery have expanded to a wide range of conditions including macular oedema from retino-vascular conditions. Formulations have been developed with the aim to provide practical, targeted, longer-term and more efficacious therapy whilst minimizing side effects. Herein, we provide a comprehensive overview of the

Blockade of Retinal Oscillations by Benzodiazepines Improves Efficiency of Electrical Stimulation in the Mouse Model of RP, rd10

“…First, inhibitory amino acids or benzodiazepines could be delivered specifically and continuously to the retina in a targeted manner. Ophthalmic systems are already applied for a controlled delivery of medicines to the posterior segment of the eye, for example, the nonbiodegradable fluocinolone acetonide intravitreal implant Iluvien (Alimera Sciences, Alpharetta, GA) or the biodegradable dexamethasone intravitreal implant Ozurdex (Allergan, Dublin, Ireland) (for review 46 ). A recent study has described the development of a nanofluidic microsystem that represents a potential platform for long-term intraocular delivery of therapeutics.…”

<p>Corneal Refractive Surgery in Patients with a History of Herpes Simplex Keratitis: A Narrative Review</p>

“…16 Although intraocular corticosteroid injections have been shown to cause HSK reactivation, the role of topical steroid drops is less clear. 85 Still, there is a theoretical risk for HSK reactivation with the use of topical steroids and, thus, for PRK and SMILE, we suggest continuing acyclovir or valacyclovir concurrently with steroid drops. If patient compliance is a concern, Miserocchi et al reported no difference in HSK recurrence between acyclovir or valacyclovir.…”

Polymer-free corticosteroid dimer implants for controlled and sustained drug delivery

“…Polymers such as polycaprolactone and poly(lactic-co-glycolic acid) (PLGA) have long been held as the gold standard polymer carrier systems for controlled drug delivery applications. Corticosteroids, which have utility in the treatment of numerous inflammatory conditions (e.g., ocular conditions 8 , osteoarthritis 9 , asthma 10 , and others 11 ), are one drug class that has benefited from the use of polymeric delivery systems, as side effects associated with their systemic use (e.g., cortisol suppression and cataracts, amongst others 12 , 13 ) can be minimized by local, controlled release 7 , 9 , 14 – 16 . Despite the advantages of these products, they are subject to limited drug loading capacity (e.g., typical systems are made up of 40–90% polymer carrier), burst release profiles, and sub-optimal release kinetics 3 , 5 , 16 , 17 , resulting in excessive drug levels leading to both local and systemic side effects, and sub-optimal dose durations 1 , 9 , 16 , 18 .…”