Intractable Ocular Diseases and Treatment Progress
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Review Article Theme: Pharmaceutical Thermal Processing - An Update Guest Editors: Feng Zhang, Michael Repka and Suresh Bandari
Intractable Ocular Diseases and Treatment Progress Xinru Zhang,1,2 Shuhan Li,1,2 Yue Tang,1,2,3
Yuzun Guo,2 and Shuai Gao2
Received 24 March 2020; accepted 27 July 2020 Abstract. In recent years, with the aging of the population and the frequent use of electronic devices, many eye diseases have shown a linear upward trend, such as dry eye disease, glaucoma, cataract, age-related macular degeneration, and diabetic retinopathy. These diseases are often chronic and difficult to cure. Based on the structure and barrier of the human eye, this review describes the pathogenesis and treatments of several intractable eye diseases and summarizes the advanced ocular drug delivery systems to provide new treatment ideas for these diseases. Finally, we also look forward to the prospect of RNAi therapy in the treatment of eye diseases. KEY WORDS: ocular barriers; intractable ocular diseases; drug delivery systems; siRNA.
INTRODUCTION
ANATOMY STRUCTURE OF THE EYE
The eye is one of the most important organs in human senses through which people perceive the world and exchange information including knowledge and memory. The eye structure is complex, which has many barriers, including the tear film barrier, the corneal barrier, the conjunctival barrier, the sclera barrier, and the blood-ocular barriers (1). These barriers can protect the eye from foreign substances, but at the same time, they limit drug delivery into the eye. In recent years, more and more people worldwide suffer from ocular diseases, which can affect eye health and even cause blindness. According to a survey, in 2015, 36 million of the 7.33 billion people on earth were blind. It is estimated that by 2050, this number will rise to 115 million people (2). Among these ocular diseases, there are several the most common and intractable ones, including dry eye disease (DED), glaucoma, cataract, age-related macular degeneration (AMD), and diabetic retinopathy (DR). This review summarizes the most common and intractable ocular diseases, including their pathological mechanisms, treatment methods, and the application of some new ocular drug delivery systems, based on the physiological structure and the barriers of the eye.
The human eye consists of the eyeball and the eye accessory organs (Fig. 1). The outer layer of the eyeball protects the eye and maintains its shape (3). The iris, distinctive colored part of the eye, controls the amount of light absorbed into the eye by changing the size of the pupil. The ciliary body produces aqueous humor and regulates the eye’s refractive power (4). The choroid nourishes the inner layer and the vitreous body. The retinal pigment epithelium (RPE) layer on the retina supports and nourishes photoreceptor cells (5). The eye content and the cornea together constitute the ocular optical system. Anatomically, the eyeball is divided into the anterior segment, including cornea, conjunctiva, iris, ciliary body, and l
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