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Editors Selection IGR 17-1
Surgical Treatment: Drainage Devices and Prolonged Drug Delivery
Comment by Ingeborg Stalmans on:
61681 Effect of Two Novel Sustained-Release Drug Delivery Systems on Bleb Fibrosis: An In Vivo Glaucoma Drainage Device Study in a Rabbit Model, Schoenberg ED; Blake DA; Swann FB et al., Translational vision science & technology, 2015; 4: 4
The authors' research focuses on the development of drug-eluting systems to be used in conjunction with glaucoma surgery. They designed and evaluated two polymer systems to be attached to an Ahmed glaucoma valve: on the one hand a non-biodegradable poly(2- hydroxyethyl methacrylate) (P[HEMA]) system with mitomycin C (MMC), and on the other hand a biodegradable poly(lactic-co-glycolic acid) (PLGA) system with 5-fluorouracil (5-FU) with and without a film releasing MMC.
5-FU did not seem to significantly reduce bleb wall thickness at either tested concentration
Preclinical testing in rabbits revealed both MMC-eluting systems to be effective in reducing bleb wall thickness (although without a difference in histological fibrosis), without significant clinical or histological signs of toxicity over a three-month postoperative period.
Interestingly, the PLGA system coated with an MMC film allowed a ten-fold reduction in MMC concentration compared with the P[HEMA] system. However, the MMC delivery period was also five to ten times shorter in the PLGA device (one to two days compared to ten days in the P[HEMA]) system), which makes it difficult to interpret the impact on safety between the two devices. The safety data during the three-month follow-up period were favorable, but this timeframe is not sufficient to understand long-term side effects of MMC.
Of note, 5-FU did not seem to significantly reduce bleb wall thickness at either tested concentration, which is consistent with the published literature indicating that 5-FU is significantly less effective than MMC as an adjunctive to glaucoma surgery.
In conclusion, the authors are to be congratulated for their efforts to improve efficacy and safety of glaucoma surgery. Further preclinical and clinical studies will be required allow to further explore this promising path.
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