Wu Kevin Y, Gao Angel, Giunta Michel, Tran Simon D
Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada.
Faculty of Medicine, Queen's University, Kingston, ON K7L 3N6, Canada.
Pharmaceuticals (Basel). 2024 Jul 30;17(8):1007. doi: 10.3390/ph17081007.
Despite significant advancements in ocular drug delivery, challenges persist in treating posterior segment diseases like macular edema (ME) and age-related macular degeneration (AMD). Suprachoroidal (SC) injections are a promising new method for targeted drug delivery to the posterior segment of the eye, providing direct access to the choroid and retina while minimizing systemic exposure and side effects. This review examines the anatomical and physiological foundations of the SC space; evaluates delivery devices such as microcatheters, hypodermic needles, and microneedles; and discusses pharmacokinetic principles. Additionally, advancements in gene delivery through SC injections are explored, emphasizing their potential to transform ocular disease management. This review also highlights clinical applications in treating macular edema, diabetic macular edema, age-related macular degeneration, choroidal melanoma, and glaucoma. Overall, SC injections are emerging as a promising novel route for administering ophthalmic treatments, with high bioavailability, reduced systemic exposure, and favorable safety profiles. Key therapeutic agents such as triamcinolone acetonide, dexamethasone, AAV-based gene therapy, and axitinib have shown promise. The field of suprachoroidal injection is progressing rapidly, and this review article, while attempting to encapsulate most of the published preclinical and clinical studies, mainly focuses on those that are published within 2023 and 2024.
尽管眼部药物递送取得了重大进展，但在治疗黄斑水肿（ME）和年龄相关性黄斑变性（AMD）等后段疾病方面仍存在挑战。脉络膜上腔（SC）注射是一种有前景的靶向药物递送至眼后段的新方法，可直接进入脉络膜和视网膜，同时将全身暴露和副作用降至最低。本文综述了脉络膜上腔空间的解剖学和生理学基础；评估了诸如微导管、皮下注射针和微针等递送装置；并讨论了药代动力学原理。此外，还探讨了通过脉络膜上腔注射进行基因递送的进展，强调了其改变眼部疾病治疗的潜力。本文还重点介绍了在治疗黄斑水肿、糖尿病性黄斑水肿、年龄相关性黄斑变性、脉络膜黑色素瘤和青光眼方面的临床应用。总体而言，脉络膜上腔注射正成为一种有前景的新型眼科治疗给药途径，具有高生物利用度、减少全身暴露和良好的安全性。诸如曲安奈德、地塞米松、基于腺相关病毒的基因疗法和阿昔替尼等关键治疗药物已显示出前景。脉络膜上腔注射领域发展迅速，本文在试图涵盖大多数已发表的临床前和临床研究的同时，主要关注2023年和2024年内发表的研究。
