title: Controlled transscleral drug delivery formulations to the eye: establishing new concepts and paradigms in ocular anti-inflammatory therapeutics and antibacterial prophylaxis.
abstract: 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.
authors.affiliation: Hospital de Olhos de Araraquara, Rua Henrique Dall'Acqua 45, Araraquara, São Paulo, CEP 14802-530, Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Paganelli
authors.forename: José A
authors.initials: JA
authors.lastname: Cardillo
authors.forename: Alessandro R J
authors.initials: AR
authors.lastname: Dare
authors.forename: Luiz A S
authors.initials: LA
authors.lastname: Melo
authors.forename: David R
authors.initials: DR
authors.lastname: Lucena
authors.forename: Arnobio A
authors.initials: AA
authors.lastname: Silva
authors.forename: Anselmo G
authors.initials: AG
authors.lastname: Oliveira
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Pizzolitto
authors.forename: Daniel
authors.initials: D
authors.lastname: Lavinsky
authors.forename: Mirian
authors.initials: M
authors.lastname: Skaf
authors.forename: Acácio A
authors.initials: AA
authors.lastname: Souza-Filho
authors.forename: Ana L
authors.initials: AL
authors.lastname: Höfling-Lima
authors.forename: Quan Dong
authors.initials: QD
authors.lastname: Nguyen
authors.forename: Baruch D
authors.initials: BD
authors.lastname: Kuppermann
authors.forename: Rocio
authors.initials: R
authors.lastname: Herrero-Vanrell
authors.forename: Rubens
authors.initials: R
authors.lastname: Belfort
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D003692:Delayed-Action Preparations; D004337:Drug Carriers