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Corticosteroids in ophthalmology: drug delivery innovations, pharmacology, clinical applications, and future perspectives

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Abstract

Corticosteroids remain the mainstay of the treatment for various ocular conditions affecting the ocular surface, anterior and posterior segments of the eye due to their anti-inflammatory, anti-oedematous, and anti-neovascularization properties. Prednisolone, prednisolone acetate, dexamethasone, triamcinolone acetonide, fluocinolone acetonide, and loteprednol etabonate are amongst the most widely used ophthalmic corticosteroids. Corticosteroids differ in their activity and potency in the eye due to their inherent pharmacological and pharmaceutical differences. Different routes and regimens are available for ocular administration of corticosteroids. Conventional topical application to the eye is the route of choice when targeting diseases affecting the ocular surface and anterior segment, while periocular, intravitreal, and suprachoroidal injections can be potentially effective for posterior segment diseases. Corticosteroid-induced intraocular pressure elevation and cataract formation remain the most significant local risks following topical as well as systemic corticosteroid administration. Invasive drug administration via intracameral, subconjunctival, and intravitreal injection can enhance ocular bioavailability and minimize dose and dosing frequency of administration, yet may exacerbate ocular side effects of corticosteroids. This review provides a critical appraisal of the ophthalmic uses of corticosteroid, routes of administration, drug delivery fundamentals and novel ocular implantable steroid delivery systems, factors influencing side effects, and future perspectives for ocular corticosteroid therapy.

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Authors and Affiliations

  1. Department of Pharmaceutics, Faculty of Pharmacy, Minia University, Minia, Egypt

    Sherif A. Gaballa, Omar Elgarhy & Hamdy Abdelkader

  2. Departments of Pharmaceutical Sciences, Ophthalmology, and Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA

    Uday B. Kompella

  3. Department of Pharmacology, College of Pharmacy, King Khalid University, Abha, 61441, Kingdom of Saudi Arabia

    Ali M. Alqahtani

  4. School of Life Science and Education, Staffordshire University, College Road, Stoke-on-Trent, ST4 2DE, UK

    Barbara Pierscionek

  5. Drug Discovery, Delivery and Patient Care Theme, Faculty of Science, Engineering and Computing, Kingston University London, Penrhyn Road, Kingston upon Thames, KT1 2EE, UK

    Raid G. Alany

  6. School of Pharmacy, The University of Auckland, Auckland, New Zealand

    Raid G. Alany

  7. Department of Pharmaceutics, Faculty of Pharmacy, Deraya University, Minia, Egypt

    Hamdy Abdelkader

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Gaballa, S.A., Kompella, U.B., Elgarhy, O. et al. Corticosteroids in ophthalmology: drug delivery innovations, pharmacology, clinical applications, and future perspectives. Drug Deliv. and Transl. Res. 11, 866–893 (2021). https://doi.org/10.1007/s13346-020-00843-z

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