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A Novel Bioerodible Deep Scleral Lamellar Cyclosporine Implant for Uveitis

¹From the Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina; ²Department of Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio; ³Department of Ophthalmology, Emory University, Atlanta, Georgia; the ⁴Emmes Corporation, Rockville, Maryland; the ⁵National Eye Institute, National Institutes of Health, Bethesda, Maryland; and the ⁶Pharmacy Department and ⁷Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland.

PURPOSE. To determine the feasibility, safety, and effectiveness of an episcleral or deep scleral lamellar sustained release cyclosporine (CsA) device in a naturally occurring animal model of uveitis.

METHODS. A two-compartment perfusion chamber was used to assess in vitro human and equine scleral permeability of fluorescein, dexamethasone-fluorescein, or CsA. A biodegradable, matrix-reservoir CsA implant was designed, and release rates of CsA were determined in vitro. Tissue CsA levels were measured in eyes with the implant. Horses with equine recurrent uveitis (ERU) received episcleral or deep scleral lamellar CsA implants and were monitored for up to 3 years.

RESULTS. Dexamethasone-fluorescein and CsA penetrated the in vitro equine sclera poorly; however, low but detectable levels of CsA were detected intraocularly in vivo. The implant placed episclerally failed to control inflammatory episodes in ERU. CsA implants placed in the deep sclera adjacent to the suprachoroidal space resulted in high levels of CsA in most ocular tissues. In clinical equine patients with ERU, frequency of uveitic flare-ups was significantly decreased after implantation of a deep scleral lamellar CsA implant.

CONCLUSIONS. Diffusion of CsA across the sclera from the episcleral space was not a feasible method of drug delivery to the equine eye. However, placing a deep scleral lamellar CsA implant adjacent to the suprachoroidal space was effective in achieving therapeutic ocular drug concentrations and controlling uveitis in horses with ERU.

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				S. H. Kim, C. J. Galban, R. J. Lutz, R. L. Dedrick, K. G. Csaky, M. J. Lizak, N. S. Wang, G. Tansey, and M. R. Robinson Assessment of Subconjunctival and Intrascleral Drug Delivery to the Posterior Segment Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging Invest. Ophthalmol. Vis. Sci., February 1, 2007; 48(2): 808 - 814. [Abstract] [Full Text] [PDF]