AAO 2024: Suprachoroidal drug delivery in the real world

Glenn C. Yiu, MD, PhD, from the University of California Davis, shared insights from his presentation on suprachoroidal drug delivery in the real world at this year's AAO meeting held in Chicago, Illinois.

Video Transcript:

Editor's note: The below transcript has been lightly edited for clarity.

Glenn C. Yiu, MD, PhD:

Hi. My name is Glenn Yiu. I'm a professor of ophthalmology at the University of California in Davis. Yesterday, I gave a talk at AAO retinas of specialty day, where I talked about the real world performance of suprachoroidal trim syndrome acetonide, the idea of suprachoroidal injections is very interesting. It's a novel idea of using a microneedle that's just long enough to penetrate the sclera without perforating into the vitreous, and it's been approved for the treatment of uveitic macular edema.

And so the question was that, you know you can do this as a method to treat uveitis, uveitic macular edema. How does it do in the real world? So we looked at the iris registry, and it turns out that, like the phase 3 PEACH TREE study in the clinical trial, up to 88% of people did not need a repeat injection within the first 12 months of the treatments. So that actually really suggests really good real world benefit in terms of long term durability of suprachoroidal trim syndrome for the treatment of UV macular edema.

I also talked at the session about what a good strategies, if you are new to using this suprachoroidal needle device, holding it very perpendicular to the eye, injecting very, very slowly, creating a constant, firm dimple to really optimize your performance of your first injection. And I talked also a little bit about upcoming strategies like the use of suprachoroidal microneedles for treatment of other diseases like neovascular AMD.

Yeah. So patient selection is important. When choosing especially your first few patients, you want to avoid patients who may be maybe highly myopic or have known scleral thinning, mainly because those patients weren't enrolled in the original phase three trials. You may also want to avoid patients who may have a lot of hardware in the area, like has glaucoma and glaucoma tubes. So choosing patients that are calm, comfortable, someone who you can be very patient with, especially for your first few injections, where you really want to take your want to take your time and do it slowly and correctly, is critical.

Yeah. So in terms of new, new advances in the development of this, of these micro needle injections, I think the most important is the use of this more as a platform device for treatment of multiple diseases and also different delivery of drugs, although right now, the suprachoroidal microneedle is only approved for the use of triamcinolon acetonide. There are currently research being developed for the use of things like excitinid, which is a tyrosine kinase inhibitor, as well as even gene therapy. In fact, our research lab has done a lot of work using microneedles to deliver adeno associated virus or AAV for gene therapy. So these are new modes by which we can potentially use the same microneedle platform for treating multiple diseases.