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

• Type of Material: Article
• Authors: J. Jeremy Chae, Georgia Institute of Technology; Jae Hwan Jung, Georgia Institute of Technology; Wei Zhu, Georgia Institute of Technology; Brandon G. Gerberich, Georgia Institute of Technology; Mohammad Reza Bahrani Fard, Georgia Institute of Technology; Hans Grossniklaus, Emory University; Christopher Ethier, Emory University; Mark Prausnitz, Emory University
• Language: English
• Date: 2020-12-07
• Publisher: Wiley
• Publication Version: Final Published Version
• Copyright Statement: © 2020 The Authors. Published by Wiley-VCH GmbH.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1002/advs.202001908
• Title of Journal or Parent Work: Advanced Science
• Volume: 8
• Issue: 2
• Start Page: 2001908
• End Page: 2001908
• Grant/Funding Information: This work was supported by a grant from the National Eye Institute (R01 EY025286) and the Georgia Research Alliance.
• Keywords: Glaucoma surgery; suprachoroidal space; Space; Technology; Science & Technology - Other Topics; Detachment; Materials Science; Release; Physical Sciences; Delivery; Trabeculectomy; Follow-up; hyaluronic acid hydrogels; Chemistry, Multidisciplinary; Chemistry; Eye; Safety; microneedle injections; Materials Science, Multidisciplinary; Nanoscience & Nanotechnology; Science & Technology; glaucoma; intraocular pressure
• Research Categories: Engineering, Biomedical; Engineering, Chemical; Health Sciences, Pharmacology; Biology, Molecular

Abstract

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.