Controlled transscleral drug delivery formulations to the eye: establishing new concepts and paradigms in ocular anti-inflammatory therapeutics and antibacterial prophylaxis.
BACKGROUND
The use of topical agents poses unique and challenging hurdles for drug delivery. Topical steroids effectively control ocular inflammation, but are associated with the well-recognized dilemma of patient compliance. Although administration of topical antimicrobials as prophylaxis is acceptable among ophthalmologists, this common practice has no sound evidence base. Developing a new antimicrobial agent or delivery strategy with enhanced penetration by considering the anatomical and physiological constraints exerted by the barriers of the eye is not a commonly perceived strategy. Exploiting the permeability of the sclera, subconjunctival routes may offer a promising alternative for enhanced drug delivery and tissue targeting.


METHODS
Ocular drug delivery strategies were reviewed for ocular inflammation and infections clinically adopted for newer class of antimicrobials, which use a multipronged approach to limit risks of endophthalmitis.


RESULTS
The analysis substantiates a new transscleral drug delivery therapeutic approach for cataract surgery.


CONCLUSIONS
A new anti-inflammatory and anti-infective paradigm that frees the patient from the nuisance of topical therapeutics is introduced, opening a large investigative avenue for future improved therapies.
Paganelli
Fernando
F
Hospital de Olhos de Araraquara, Rua Henrique Dall'Acqua 45, Araraquara, São Paulo, CEP 14802-530, Brazil.
Cardillo
José A
JA
Dare
Alessandro R J
AR
Melo
Luiz A S
LA
Lucena
David R
DR
Silva
Arnobio A
AA
Oliveira
Anselmo G
AG
Pizzolitto
Antonio C
AC
Lavinsky
Daniel
D
Skaf
Mirian
M
Souza-Filho
Acácio A
AA
Höfling-Lima
Ana L
AL
Nguyen
Quan Dong
QD
Kuppermann
Baruch D
BD
Herrero-Vanrell
Rocio
R
Belfort
Rubens
R
D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000737:chemistry / Q000493:pharmacokinetics; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000378:metabolism / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D002387:Cataract Extraction; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000627:therapeutic use; D004337:Drug Carriers; D016503:Drug Delivery Systems; D009877:Endophthalmitis / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology; D005123:Eye / Q000187:drug effects* / Q000378:metabolism / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008863:Microspheres; D053758:Nanoparticles / Q000008:administration & dosage / Q000627:therapeutic use; D012590:Sclera
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D003692:Delayed-Action Preparations; D004337:Drug Carriers