Drug‐Free, Nonsurgical Reduction of Intraocular Pressure for Four Months after Suprachoroidal Injection of Hyaluronic Acid Hydrogel,Advanced Science

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Drug‐Free, Nonsurgical Reduction of Intraocular Pressure for Four Months after Suprachoroidal Injection of Hyaluronic Acid Hydrogel
Advanced Science ( IF 14.3 ) Pub Date : 2020-12-07 , DOI: 10.1002/advs.202001908
J Jeremy Chae ₁ , Jae Hwan Jung _{1,

2} , Wei Zhu _{3,

4} , Brandon G Gerberich ₃ , Mohammad Reza Bahrani Fard ₅ , Hans E Grossniklaus ₆ , C Ross Ethier _{3,

5} , Mark R Prausnitz _{1,

3}

Affiliation

Glaucoma is the leading cause of irreversible blindness. Current treatments use drugs or surgery to reduce intraocular pressure (IOP). In this study, a drug‐free, nonsurgical method is developed that lowers IOP for 4 months without requiring daily patient adherence. The approach involves expanding the suprachoroidal space (SCS) of the eye with an in situ‐forming hydrogel injected using a microneedle. This study tests the hypothesis that SCS expansion increases the drainage of aqueous humor from the eye via the unconventional pathway, which thereby lowers IOP. SCS injection of a commercial hyaluronic acid (HA) hydrogel reduces the IOP of normotensive rabbits for more than 1 month and an optimized HA hydrogel formulation enables IOP reduction for 4 months. Safety assessment by clinical ophthalmic examinations indicate the treatment is well tolerated. Histopathology shows minor hemorrhage and fibrosis at the site of injection. Further analysis by ultrasound biomicroscopy demonstrates a strong correlation of IOP reduction with SCS expansion. Outflow facility measurements show no difference in pressure‐dependent outflow by the conventional pathway between treated and untreated eyes, supporting the hypothesis. In conclusion, SCS expansion with an in situ‐forming hydrogel can enable extended IOP reduction for treating ocular hypertension and glaucoma without drugs or surgery.

中文翻译：

脉络膜上注射透明质酸水凝胶后四个月无药物、非手术降低眼压

青光眼是导致不可逆失明的主要原因。目前的治疗方法是使用药物或手术来降低眼压（IOP）。在这项研究中，开发了一种无药物、非手术的方法，可以降低眼压达 4 个月，且不需要患者每天坚持。该方法涉及使用微针注射原位形成的水凝胶来扩大眼睛的脉络膜上腔（SCS）。这项研究检验了这样的假设：SCS 扩张会通过非常规途径增加眼房水的排出，从而降低眼压。SCS 注射商业透明质酸 (HA) 水凝胶可降低正常血压兔子的 IOP 1 个月以上，优化的 HA 水凝胶配方可降低 IOP 4 个月。临床眼科检查的安全性评估表明该治疗具有良好的耐受性。组织病理学显示注射部位有轻微出血和纤维化。超声生物显微镜的进一步分析表明，眼压降低与 SCS 扩张有很强的相关性。流出设施测量显示，经治疗和未治疗的眼睛之间传统路径的压力依赖性流出没有差异，支持了这一假设。总之，利用原位形成水凝胶进行 SCS 扩张可以实现延长眼压降低，从而无需药物或手术即可治疗高眼压和青光眼。

更新日期：2021-01-20

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