Bertram James P, Saluja Sandeep S, McKain Jodi, Lavik Erin B
Department of Biomedical Engineering, Yale University, New Haven, CT, USA.
J Microencapsul. 2009 Feb;26(1):18-26. doi: 10.1080/02652040802095250.
It is estimated that 2.2 million people have glaucoma in the US and 67 million people worldwide. The majority of cases are associated with elevated intraocular pressure (IOP) and decreasing IOP eliminates or greatly reduces degeneration in most cases, including cases in which the IOP is in the normal range but optic neuropathy occurs. Timolol maleate has the longest record of safety and efficacy to lower IOP and is administered via eye drops one or more times per day. Unfortunately, compliance is poor across patient populations leading to degeneration. Patients typically see their ophthalmologist once every 3-4 months. If one could administer a long-acting treatment while in the doctor's office, one might overcome the compliance issue and effectively preserve sight. The critical step is to develop a formulation for timolol maleate that leads to sustained delivery for greater than 90 days and would permit a different treatment paradigm, namely subconjunctival administration once every 3-4 months. By using a 50 : 50 blend of PLGA 502H and PLA, this study was able to fabricate microspheres that delivered timolol maleate continually over 107 days, well within the time frame needed to make subconjunctival administration feasible and permit a new approach to treating glaucoma and diseases of the eye more broadly.
据估计,美国有220万人患有青光眼,全球有6700万人患病。大多数病例与眼压升高有关,在大多数情况下,降低眼压可消除或大大减少视神经退化,包括眼压在正常范围内但发生视神经病变的病例。马来酸噻吗洛尔降低眼压的安全性和有效性记录最长,通过滴眼液每天给药一次或多次。不幸的是,各患者群体的依从性都很差,导致病情恶化。患者通常每3至4个月看一次眼科医生。如果能在医生办公室进行长效治疗,或许可以克服依从性问题并有效保护视力。关键步骤是开发一种马来酸噻吗洛尔制剂,使其能持续给药超过90天,并允许采用不同的治疗模式,即每3至4个月进行一次结膜下给药。通过使用50:50的聚乳酸-羟基乙酸共聚物502H和聚乳酸混合物,本研究能够制备出微球,使马来酸噻吗洛尔持续释放107天,这完全在使结膜下给药可行并允许更广泛地治疗青光眼和眼部疾病所需的时间范围内。