Topical Anti-Inflammatory Agents for Non-Infectious Uveitis: Current Treatment and Perspectives

Balasubramaniam, Balini; Chong, Yu Jeat; Azzopardi, Matthew; Logeswaran, Abison; Denniston, Alastair K.O.

doi:10.2147/jir.s288294

Cited by 10 publications

(8 citation statements)

References 96 publications

(77 reference statements)

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“…Trans-topical delivery involves the instillation of drops or ointments to the ocular surface. Using this route, therapeutics may be delivered to varying depths within the eye ranging from the superficial surface, in the case of keratoconjunctivitis, to the posterior segment in the adjunct treatment of posterior segment uveitis 47 . As the therapeutic target progresses deeper into the eye, it becomes increasingly difficult to identify drugs capable of overcoming the static and dynamic barriers within the eye to reach this target.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of ultrasound-mediated drug delivery to the eye and critical insights to facilitate a timely path to the clinic

Rad,

Chapman,

Tupally

et al. 2023

Theranostics

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Ultrasound has long been identified as a promising, non-invasive modality for improving ocular drug delivery across a range of indications. Yet, with 20 years of learnings behind us, clinical translation remains limited. To help address this, and in accordance with PRISMA guidelines, the various mechanisms of ultrasound-mediated ocular drug delivery have been appraised, ranging from first principles to emergent applications spanning both ex vivo and in vivo models. The heterogeneity of study methods precluded meta-analysis, however an extensive characterisation of the included studies allowed for semi-quantitative and qualitative assessments. Methods: In this review, we reflected on study quality of reporting, and risk of bias (RoB) using the latest Animal Research: Reporting of In Vivo Experiments (ARRIVE 2.0) guidelines, alongside the Systematic Review Centre for Laboratory animal Experimentation (SYRCLE) RoB tools. Literature studies from 2002 to 2022 were initially characterised according to methods of ultrasound application, ultrasound parameters applied, animal models employed, as well as safety and efficacy assessments. This exercise contributed to developing a comprehensive understanding of the current state of play within ultrasound-mediated ocular drug delivery. The results were then synthesised and processed into a guide to aid future study design, with the goal of improving the reliability of data, and to support efficient and timely translation to the clinic. Results: Key attributes identified as hindering translation included: poor reporting quality and high RoB, skewed use of animals unrepresentative of the human eye, and the over reliance of reductionist safety assessments. Ex vivo modelling studies were often unable to have comprehensive safety assessments performed on them, which are imperative to determining treatment safety, and represent a pre-requisite for clinical translation. Conclusion:With the use of our synthesised guide, and a thorough understanding of the underlying physicochemical interactions between ultrasound and ocular biology provided herein, this review offers a firm foundation on which future studies should ideally be built, such that ultrasound-mediated ocular drug delivery can be translated from concept to the coalface where it can provide immense clinical benefit.

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Section: Resultsmentioning

confidence: 99%

A systematic review of ultrasound-mediated drug delivery to the eye and critical insights to facilitate a timely path to the clinic

Rad,

Chapman,

Tupally

et al. 2023

Theranostics

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“…Conversely, intermediate, posterior and panuveitis require systemic steroid treatment from the beginning due to the low penetrance of topical agents in the posterior eye sector [100]. Intraocular implants with dexamethasone or fluocinolone could be an effective alternative [101,102], minimizing the dose or frequency of administration, but at the same time exacerbating ocular side effects such as cataract formation, ocular hypertension, and glaucoma or chorioretinopathy [103].…”

Section: Treatmentmentioning

confidence: 99%

Ophthalmological Manifestations in Inflammatory Bowel Diseases: Keep an Eye on It

Migliorisi,

Vella,

Dal Buono

et al. 2024

Cells

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Background and aims: Inflammatory bowel diseases (IBD) are multifactorial chronic inflammatory disorders affecting the gastrointestinal tract. However, a broad spectrum of extraintestinal manifestations (EIMs) is associated with IBD, affecting several organs and systems, such as the skin, musculoskeletal and hepatobiliary systems, and, not least, the eye. Approximately 10% of IBD patients can develop ocular EIMs (O-EIMs) with a higher prevalence in Crohn’s disease (CD). Eye-redness, photophobia, pain, and blurred vision are the common symptoms, with a wide rate of severity and clinical impact on the quality of life. This narrative review aims to summarize the prevalence, pathogenesis, and current evidence-based management of O-EIMs, underlying the importance of a holistic approach and specialties collaboration for a prompt diagnosis and treatment. Methods: PubMed was searched up to December 2023 to identify relevant studies investigating the pathogenesis, epidemiology, and treatment of O-EIMs in IBD patients. Results: The mechanisms underlying O-EIMs are partially unknown, encompassing immune dysregulation, shared antigens between the eye and the gut, genetic predisposition, and systemic inflammation driven by high levels of interleukins and cytokines in IBD patients. The complexity of O-EIMs’ pathogenesis reflects in the management of these conditions, varying from topical and systemic steroids to immunomodulatory molecules and biologic therapy, such as anti-tumor necrosis factor (TNF)-alpha. A multidisciplinary approach is the backbone of the management of O-EIMs.

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“…Glucocorticoids are the first-line treatment option for NIU and are mainly used for rapid control of inflammation. Its main mechanism of action is that glucocorticoid molecules bind to soluble receptors in the cytoplasm, and the resulting complex induces or inhibits the transcription of certain mRNAs and down-regulates the expression of pro-inflammatory factors [6] [14], which in turn exerts an anti-inflammatory-action. The main treatment modalities include topical drop therapy, periocular therapy, intravitreal therapy, etc.…”

Section: Glucocorticoidsmentioning

confidence: 99%

“…NIU is more common than infectious uveitis. Studies are showing that it has a prevalence of 41% -55% in China, 35% -43% in Japan, and 25% -45% in India [6]. An epidemiological study found that the prevalence of NIU in Australia was 80% [7].…”

Section: Introductionmentioning

confidence: 99%

Progress in the Use of Glucocorticoids and Biological Agents in Non-Infectious Uveitis

Liu,

Zou,

Cheng

et al. 2024

JBM

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Topical Anti-Inflammatory Agents for Non-Infectious Uveitis: Current Treatment and Perspectives

Cited by 10 publications

References 96 publications

A systematic review of ultrasound-mediated drug delivery to the eye and critical insights to facilitate a timely path to the clinic

A systematic review of ultrasound-mediated drug delivery to the eye and critical insights to facilitate a timely path to the clinic

Ophthalmological Manifestations in Inflammatory Bowel Diseases: Keep an Eye on It

Progress in the Use of Glucocorticoids and Biological Agents in Non-Infectious Uveitis

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