Yasukawa Tsutomu, Ogura Yuichiro, Sakurai Eiji, Tabata Yasuhiko, Kimura Hideya
Kurashiki Central Hospital, Kurashiki 710-8602, Japan; Department of Ophthalmology, Nagoya City University Medical School, Aichi 467-8601, Japan.
Adv Drug Deliv Rev. 2005 Dec 13;57(14):2033-46. doi: 10.1016/j.addr.2005.09.005. Epub 2005 Nov 2.
Vitreoretinal diseases involving age-related macular degeneration (AMD) are refractory to most topical or systemic drugs. The retina and the vitreous cavity have a unique position regarding pharmacokinetics in that the inner and outer blood retinal barriers separate the retina and vitreous from the systemic circulation. Eye drops achieve minimal therapeutic concentrations in the vitreoretinal tissue. Drug delivery systems are a strategy to address this. Intraocular sustained drug release using implantable devices has been investigated to treat vitreoretinal diseases. Possible targeted diseases include those in which repeated intraocular injections are effective (cytomegalovirus retinitis, uveitis), diseases requiring surgery (proliferative vitreoretinopathy), and chronic diseases (AMD, macular edema, retinitis pigmentosa). Hydrophobic or hydrophilic polymers shaped into a sheet, disc, rod, plug, or a larger device can be implanted into the subretinal space, intrascleral space, vitreous space, peribulbar space, or at the pars plana. Many researchers suggest the feasibility of these implants to treat AMD.
涉及年龄相关性黄斑变性(AMD)的玻璃体视网膜疾病对大多数局部或全身用药均难以治愈。视网膜和玻璃体腔在药代动力学方面具有独特的地位,因为视网膜内、外屏障将视网膜和玻璃体与体循环分隔开来。眼药水在玻璃体视网膜组织中达到的治疗浓度极低。药物递送系统是解决这一问题的一种策略。使用可植入装置进行眼内持续药物释放已被研究用于治疗玻璃体视网膜疾病。可能适用的疾病包括那些反复眼内注射有效的疾病(巨细胞病毒性视网膜炎、葡萄膜炎)、需要手术治疗的疾病(增殖性玻璃体视网膜病变)以及慢性疾病(AMD、黄斑水肿、色素性视网膜炎)。可将疏水或亲水聚合物制成薄片、圆盘、棒状、塞子或更大的装置,植入视网膜下间隙、巩膜内间隙、玻璃体腔、球周间隙或睫状体扁平部。许多研究人员认为这些植入物治疗AMD具有可行性。