Efficacy and safety of sustained-release intraocular drug therapy for glaucoma: a systematic review of randomized controlled trials
Main Article Content
Abstract
BACKGROUND
Glaucoma is a leading cause of irreversible blindness worldwide. Although intraocular pressure (IOP) reduction remains the cornerstone of treatment, limitations of long-term topical therapy, including poor adherence and ocular surface complications, have increased interest in sustained-release intraocular drug delivery systems. This systematic review evaluated the efficacy and safety of sustained-release intraocular implants in patients with glaucoma or ocular hypertension.
METHODS
A systematic search of PubMed, ScienceDirect, Scopus, and the Cochrane Library was conducted for randomized controlled trials (RCT) published between January 2021 and September 2025. Double-blind RCT were selected according to PRISMA guidelines and appraised using the JBI Critical Appraisal Checklist. Data were synthesized narratively. Four RCTs met the eligibility criteria and were included. The studies evaluated travoprost and bimatoprost intracameral implants with follow-up durations of 12-36 months.
RESULTS
All studies demonstrated significant IOP reduction and non-inferiority to timolol. Least-squares mean diurnal IOP reduction ranged from −5.4 to −8.5 mmHg with travoprost implants and −6.2 to −7.8 mmHg with bimatoprost implant. The proportion of patients remaining free from adjunctive topical therapy ranged from 63% to 81%. Adverse events were generally mild and transient. However, travoprost implants showed no clinically significant corneal endothelial cell loss (CECL), whereas bimatoprost implant resulted in CECL ≥ 20% in 8.1% (10 µg) and 24.4% (15 µg) of patients, leading to restriction of single administration per eye.
CONCLUSION
Sustained-release intraocular implants provide effective and durable IOP reduction while potentially improving treatment adherence. However, implant selection should consider ocular anatomy and corneal endothelial safety.
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