Steroid-eluting contact lenses for corneal and intraocular inflammation.

Ocular inflammation is one of the leading causes of blindness worldwide, and steroids in topical ophthalmic solutions (e.g. dexamethasone eye drops) are the mainstay of therapy for ocular inflammation. For many non-infectious ocular inflammatory diseases, such as uveitis, eye drops are administered as often as once every hour. The high frequency of administration coupled with the side effects of eye drops leads to poor adherence for patients. Drug-eluting contact lenses have long been sought as a potentially superior alternative for sustained ocular drug delivery; but loading sufficient drug into contact lenses and control the release of the drug is still a challenge. A dexamethasone releasing contact lens (Dex-Lens) was previously developed by encapsulating a dexamethasone-polymer film within the periphery of a hydrogel-based contact lens. Here, we demonstrate safety and efficacy of the Dex-Lens in rabbit models in the treatment of anterior ocular inflammation. The Dex-Lens delivered drug for 7 days in vivo (rabbit model). In an ocular irritation study (Draize test) with Dex-Lens extracts, no adverse events were observed in normal rabbit eyes. Dex-Lenses effectively inhibited suture-induced corneal neovascularization and inflammation for 7 days and lipopolysaccharide-induced anterior uveitis for 5 days. The efficacy of Dex-Lenses was similar to that of hourly-administered dexamethasone eye drops. In the corneal neovascularization study, substantial corneal edema was observed in rabbit eyes that received no treatment and those that wore a vehicle lens as compared to rabbit eyes that wore the Dex-Lens. Throughout these studies, Dex-Lenses were well tolerated and did not exhibit signs of toxicity. Dexamethasone-eluting contact lenses may be an option for the treatment of ocular inflammation and a platform for ocular drug delivery. STATEMENT OF SIGNIFICANCE: Inflammation of the eye can happen either on the ocular surface (i.e. the cornea) or inside the eye, both of which can result in loss of vision or even blindness. Ocular inflammation is normally treated by steroid eye drops. Depending on the type and severity of inflammation, patients may have to take drops every hour for days at a time. Such severe dosing regimen can lead to patients missing doses. Also, more than 95% drug in an eye drop never goes inside the eye. Here we present a contact lens that release a steroid (dexamethasone) for seven days at a time. It is much more efficient than eye drops and a significant improvement since once worn, the patient will avoid missing doses.

Topical sustained drug delivery to the retina with a drug-eluting contact lens.

Intravitreal injections and implants are used to deliver drugs to the retina because therapeutic levels of these medications cannot be provided by topical administration (i.e. eye drops). In order to reach the retina, a topically applied drug encounters tear dilution, reflex blinking, and rapid fluid drainage that collectively reduce the drug's residence time on the ocular surface. Residing under the tears, the cornea is the primary gateway into the eye for many topical ophthalmic drugs. We hypothesized that a drug-eluting contact lens that rests on the cornea would therefore be well-suited for delivering drugs to the eye including the retina. We developed a contact lens based dexamethasone delivery system (Dex-DS) that achieved sustained drug delivery to the retina at therapeutic levels. Dex-DS consists of a dexamethasone-polymer film encapsulated inside a contact lens. Rabbits wearing Dex-DS achieved retinal drug concentrations that were 200 times greater than those from intensive (hourly) dexamethasone drops. Conversely, Dex-DS demonstrated lower systemic (blood serum) dexamethasone concentrations. In an efficacy study in rabbits, Dex-DS successfully inhibited retinal vascular leakage induced by intravitreal injection of vascular endothelial growth factor (VEGF). Dex-DS was found to be safe in a four-week repeated dose biocompatibility study in healthy rabbits.

Incorporation of polymerizable surfactants in hydroxyethyl methacrylate lenses for improving wettability and lubricity.

Dryness and discomfort are the main reasons for dropouts in contact lens wearers. Incorporating surfactants in lens formulations could improve wettability and lubricity, which can improve comfort. We have focused on incorporating polymerizable surfactants in hydroxyethyl methacrylate lenses to improve comfort, while minimizing the potential for surfactant release into the tears. The surfactants were added to the polymerization mixture, followed by UV curing and extraction of leachables in hot water. Wettability and lubricity were characterized by measuring the contact angle and coefficient of friction. Lenses were also characterized by measuring transmittance, loss and storage moduli and ion permeability. Incorporation of surfactants significantly reduced contact angle from 90° for p-HEMA gels to about 10° for 2.43% (w/w) surfactant loading in hydrated gel. The coefficient of friction also decreased from about 0.16 for HEMA gels to 0.05 for the gels with 2.43% surfactant loading. There was a good correlation between the contact angle and coefficient of friction suggesting that both effects can be related to the stretching of the surfactant tails near the surface into the aqueous phase. The water content was also correlated with the surfactant loading but the contact angle was more sensitive suggesting that the observed improvements in wettability and lubricity arise from the protrusion of the surfactant tails in into the liquid, and not purely from the increase in the water content. The gels were clear and certain compositions also have the capability to block UVC and UVB radiation. The results suggest that incorporation of polymerizable surfactants could be useful in improving surface properties without significantly impacting any bulk property.

Contact lenses as a platform for ocular drug delivery.

INTRODUCTION: Most ophthalmic drugs are delivered through eye drops even though only about 1 - 5% of the drug reaches the target tissue and the patient compliance is not good. Drug-eluting contact lenses could significantly increase bioavailability, reduce side effects and improve patient compliance. AREAS COVERED: Recent research on drug-eluting contact lenses has focused on increasing the release duration through molecular imprinting, dispersion of barriers or nanoparticles, increasing drug binding to the polymer, sandwiching a PLGA (poly[lactic-co-glycolic acid]) layer in a lens and developing novel materials. This review covers all these studies with a specific focus on the transport mechanisms and advantages and disadvantages of each approach. EXPERT OPINION: The main reason for prior failures was the short duration of release from the lenses. The new technologies can provide extended drug release for hours to days. The in vivo animal and clinical studies have proven the safety and efficacy of drug-eluting contact lenses, while showing considerable improvements compared to eye drops. The future appears to be promising but several challenges remain such as processing and storage issues, regulatory hurdles, high costs of clinical studies, potential lack of acceptance by the elderly, etc.

Aggregation and transport of Brij surfactants in hydroxyethyl methacrylate hydrogels.

Surfactant loaded polymeric hydrogels find applications in several technological areas including drug delivery. Drug transport can be attenuated in surfactant loaded gels through partitioning of the drug in the surfactant aggregates. The drug transport depends on the type of the aggregates and also on the surfactant transport because diffusion of the surfactant leads to dissolution of the aggregates. The drug and the surfactant transport can be characterized by the surfactant monomer diffusivity Ds. and the critical aggregation concentration C(*). Here we focus on the transport in hydroxyethyl methacrylate (HEMA) hydrogels loaded with three different types of Brij surfactants. We measure transport of a hydrophobic drug cyclosporine and the surfactant for surfactant loadings ranging from 0.1% to 8%, and utilize the data to predict the values of Ds. and C(*). We show that the predictions based on surfactant transport are significantly different from those based on modeling the drug transport. The differences are attributed to the assumption of just one type of aggregate in the gel irrespective of the total concentration. The transport data suggests existence of multiple types of aggregates and this hypothesis is validated for Brij 98 by imaging of the microstructure with free fracture SEM.

Extended delivery of an anionic drug by contact lens loaded with a cationic surfactant.

Drug eluding contact lenses can be very effective vehicles for ophthalmic drug delivery, but are incapable of releasing drug for more than a few hours. We propose to optimize the interactions of the polymer matrix of the contact lens with the hydrophobic tails of ionic surfactants to adsorb the surfactant molecules on the polymer with high packing and thus create a high surface charge. Ionic drugs can then adsorb on the charged surfactant coated surfaces with high affinity to reduce the transport rates, leading to extended release. Specifically, we show control release of an anionic drug dexamethasone 21-disodium phosphate from poly-hydroxyethyl methacrylate (p-HEMA) contact lenses by utilizing cationic surfactant (cetalkonium chloride). The partition coefficient of the drug increase exponentially with surfactant loading in the gel in at least qualitative agreement with the Debye-Hückel theory. The drug adsorbs on the surfactant covered polymer, and can also diffuse along the surface with diffusivity lower than that for the free drug, leading to a reduction in the effective diffusivity, which is the weighted combination of the free and surface diffusivities. The addition of surfactant did not impact transparency of lenses, and had additional benefits of increase in wettability and significant reduction in protein absorption. With a surfactant loading of about 10%, the drug release duration was increased from about 2 h to 50 h in 1-day ACUVUE(®) contact lenses, proving the viability of using surfactant for increasing drug release durations.

Lysozyme transport in p-HEMA hydrogel contact lenses.

Protein binding in hydrogels adversely affects their performance and can interfere with their usage in several biomedical applications including contact lenses. In this study we focus on understanding and modeling the mechanisms of protein transport in hydrogels, specifically focusing on the effect of protein concentration and gel crosslinking on transport. Specifically, we focus on lysozyme, the most abundant protein in tear fluid, and hydrogels of poly-hydroxyethyl methacrylate (p-HEMA), a common contact lens material. Protein uptake experiments with gels of different thicknesses showed a time scale increase as the square of the thickness suggesting diffusion controlled transport. Partition coefficient was found to be dependent on the equilibrium concentration of lysozyme, and also on the degree of crosslinking. Since transport is related to mesh size, gel modulus was obtained for various crosslinkings and utilized to estimate the mesh size. The transport data were fitted to a diffusion model and the fitted diffusivity was compared to diffusivity predicted from a model based on hydrogel mesh size. Both protein absorption and desorption data fitted the diffusion model with the same value of diffusivity, but the experimentally measured diffusivities were significantly smaller than those estimated on the basis of the gel mesh size. Models were modified to take into account protein binding to the polymer but the modified predictions were still larger than the measured values. The results of this study could assist in the development of contact lens materials that exhibit minimal protein binding, in designing cleaning regimens for protein removal from contact lenses, and in applications related to protein binding in several other biomaterials.