OSLI Retina

March 2020

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132 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina Practical Retina Incorporating current trials and technology into clinical practice Emerging Drug Delivery Systems for Posterior Segment Disease by David Levine, MD; Thomas A. Albini, MD; and Steven Yeh, MD The eye, despite its diminutive size of roughly 8 grams, is a tremendous target for drug de- livery systems. The anatomic acces- sibility of the eye and the capacity to directly visualize and image ocular tissues to measure the response to therapy are dis- tinct advantages of ophthalmic drug delivery compared with other organs in the body. Yet there exist many challenges to delivering a therapeutic agent to the appropriate intraocular location, not the least of which is the blood-ocular barrier. The intravitreal injection has been the mainstay of treatment for the retina specialist for more than a de- cade in treating a number of blinding conditions such as macular degenera- tion, retinovascular disease, and dia- betic retinopathy. The high treatment burden of repeated injections has led to the introduction of several innova- tive approaches, including drug elut- ing polymers, surgically implanted reservoirs, and suprachoroidal drug delivery. In this installment of Practical Retina, David Levine, MD, and Steven Yeh, MD, of the Emory Eye Center in Atlanta, and Thomas A. Albini, MD, of the Bascom Palmer Eye Institute in Miami highlight several exciting drug delivery systems recently U.S. Food and Drug Administration approved, as well as emerging technologies in late- phase clinical trials. The use of intravitreal injection therapy for age-related macular degeneration, retinal vascular disease, and uveitis has revolutionized our ability to effectively treat a myriad of posterior segment diseases and is the preferred method for drug delivery to the posterior segment. Within the United States alone, the number of intravitreal injections has increased dramatically from 4,500 injections in 2001 to more than 2 million injections by 2012, 1 and this number continues to rise. Given the rapidly increasing number of intravitreal therapeutics and treatment burden for patients, there has been consid- erable interest in the development of ther- apies that improve durability. Novel ap- proaches in drug delivery systems include the development of longer-acting intravit- real medications, refillable drug reservoirs, and a suprachoroidal drug delivery plat- form. An understanding of these technolo- gies will be needed both for their imple- mentation in clinical practice and for the assessment of each platform's benefit-risk profile. This review summarizes emerging drug delivery platforms that aim to provide advantages to currently administered intra- vitreal therapies. FLUOCINOLONE ACETONIDE 0.19 MG (ILUVIEN) Fluocinolone acetonide 0.19 mg is an injectable fluocino- lone acetonide insert (Iluvien; Alimera Sciences, Alpharetta, GA), which was U.S. Food and Drug Administration (FDA)- approved in 2014 for the treatment of diabetic macular edema (DME) in patients who have previously received corticoste- roid and did not have a rise in intraocular pressure (IOP). It is designed to release 0.25 µg of fluocinolone per day. Campo- Thomas A. Albini David Levine Steven Yeh doi: 10.3928/23258160-20200228-01 Howard F. Fine Practical Retina Co-Editor

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