WO2017120600A1

WO2017120600A1 - Compositions and methods of treating wet age-related macular degeneration

Info

Publication number: WO2017120600A1
Application number: PCT/US2017/012755
Authority: WO
Inventors: Samirkumar PATEL
Original assignee: Clearside Biomedical, Inc.
Priority date: 2016-01-08
Filing date: 2017-01-09
Publication date: 2017-07-13

Abstract

This invention is generally related to ophthalmic therapies, and more particularly to methods and devices that allow for infusion of a fluid drug formulation into posterior ocular tissues for targeted, localized treatment, for example, for the treatment of wet AMD. In some embodiments, the drug formulation includes a tyrosine kinase inhibitor and is injected into suprachoroidal space (SCS) to provide localized drug in the choroid and retina. In a further embodiment, the tyrosine kinase inhibitor has activity against vascular endothelial growth factor (VEGF) and/or platelet derived growth factor (PDGF). In even a further embodiment, the tyrosine kinase inhibitor is axitinib.

Description

COMPOSITIONS AND METHODS OF TREATING WET AGE-RELATED MACULAR

DEGENERATION

CROSS REFERENCE TO RELATED APPLICATIONS

[0001] This application claims priority to U.S. Provisional Application No. 62/276,547, filed on January 8, 2016, which is hereby incorporated by reference in its entirety.

BACKGROUND OF THE INVENTION

[0002] Treatment of chronic retinal diseases, such as neovascular (wet) age related macular degeneration (AMD), often require intravitreal injections of a biological drug, such as Lucentis, Eylea or Avastin to prevent vision loss. Additionally, wet AMD patients often show new blood vessel formation from the choroid. Wet AMD affects the choroid and retina and specific targeting of these tissues might is therefore needed in modulating disease progression.

[0003] Macular degeneration, also known as age-related macular degeneration (AMD or ARMD), is a medical condition which may result in blurred or no vision in the center of the visual field. Early on there are often no symptoms. Over time, however, some people experience a gradual worsening of vision that may affect one or both eyes. While it does not result in complete blindness, loss of central vision can make it hard to recognize faces, drive, read, or perform other activities of daily life. Visual hallucinations may also occur but these are not serious and do not represent a mental illness. Macular degeneration typically occur in older people. Genetic factors and smoking also play a role. It is due damage to the macula of the retina. Diagnosis is by a complete eye exam. The severity is divided into early, intermediate, and late types. The late type is additionally divided into "dry" and "wet" forms with the dry form making up 90% of cases.

[0004] Neovascular or exudative AMD, the "wet" form of advanced AMD, causes vision loss due to abnormal blood vessel growth (choroidal neovascularization) in the choriocapillaris, through Bruch's membrane. The proliferation of abnormal blood vessels in the retina is stimulated by vascular endothelial growth factor (VEGF). Unfortunately, these new vessels are fragile, ultimately leading to blood and protein leakage below the macula. Bleeding, leaking, and scarring from these blood vessels eventually cause irreversible damage to the photoreceptors and rapid vision loss if left untreated.

[0005] Choroidal neovascularization (CNV) is the creation of new blood vessels in the choroid layer of the eye. Choroidal neovascularization is a common cause of neovascular degenerative maculopathy (i.e. 'wet' macular degeneration)¹¹¹ commonly exacerbated by extreme myopia, malignant myopic degeneration, or age-related developments. CNV can occur rapidly in individuals with defects in Bruch's membrane, the innermost layer of the choroid. It is also associated with excessive amounts of VEGF. As well as in wet macular degeneration, CNV can also occur frequently with the rare genetic disease pseudoxanthoma elasticum and rarely with the more common optic disc drusen. CNV has also been associated with extreme myopia or malignant myopic degeneration, where in choroidal neovascularization occurs primarily in the presence of cracks within the retinal (specifically) macular tissue known as lacquer cracks. CNV can create a sudden deterioration of central vision, noticeable within a few weeks. Other symptoms which can occur include colour disturbances, and metamorphopsia (distortions in which straight lines appears wavy). Hemorrhaging of the new blood vessels can accelerate the onset of symptoms of CNV.

[0006] The pathogenesis of age-related macular degeneration is not well known, although a number of theories have been put forward, including oxidative stress, mitochondrial dysfunction, and inflammatory processes.

[0007] The imbalance between production of damaged cellular components and degradation leads to the accumulation of detrimental products, for example, intracellular lipofuscin and extracellular drusen. Incipient atrophy is demarcated by areas of RPE thinning or depigmentation that precede geographic atrophy in the early stges of AMD. In advanced stages of AMD, atrophy of the RPE (geographic atrophy) and/or development of new blood vessels (neovascularization) result in death of photoreceptors and central vision loss.

[0008] In the dry (nonexudative) form, cellular debris called drusen accumulates between the retina and the choroid, causing atrophy and scarring to the retina. In the wet (exudative) form, which is more severe, blood vessels grow up from the choroid (neovascularization) behind the retina which can leak exudate and fluid and also cause hemorrhaging. [0009] In the wet form, laser coagulation or photodynamic therapy may slow worsening. However, laser coagulation is feasible in only limited cases. Only about 15 out of 100 cases can be effectively treated with laser photocoagulation surgery. The surgery works best when the abnormal blood vessels (choroidal neovascularization) are clustered close together in a specific area. Blood vessels that are scattered over a wider area are much harder to treat. Surgery is also less helpful after the abnormal blood vessels reach the center of the macula (fovea). The procedure cannot restore lost vision, only slow progession of the disease. Laser treatment almost always causes some immediate, permanent central vision loss (a central blind spot). And laser treatment does not always prevent future growth of abnormal blood vessels.

[0010] In photodynamic therapy, a light-sensitive medicine called verteporfin (Visudyne) is injected into the bloodstream. The medicine collects in the abnormal blood vessels under the macula. Laser light is then shone into the eye, which activates the medicine and causes it to create blood clots that block the abnormal blood vessels. By sealing the leaky blood vessels, photodynamic therapy slows down (a) the buildup of fluid under the retina that distorts the shape and position of the macula, (b) the growth of scar tissue and the abnormal membrane under the retina, both of which damage the cells in the macula, and (c) central vision loss. PDT can lower the risk of severe vision loss by reducing the growth of and leakage from abnormal blood vessels under the retina. How well the treatment works depends on where and how the abnormal blood vessels are growing beneath the retina. For some types of wet AMD, the treatment has no detectable benefit. The effect of PDT in slowing the progress of AMD is often temporary, and the abnormal blood vessels begin leaking again after about 3 months. Most people need multiple treatments to get the full benefits of the therapy.

[0011] Wet AMD may also be treated with medication that stops and sometimes reverses the growth of blood vessels. A randomized control trial found that bevacizumab and ranibizumab had similar efficacy, and reported no significant increase in adverse events with bevacizumab. Bevacizumab however is not FDA approved for treatment of macular degeneration.

[0012] Currently, even the most successful treatments of wet AMD do not preclude reoccurrence, making multiple treatments likely. In addition, currently available treatments do not restore vision that has already been lost. Therefore, there is a need in the art of macular degeneration treatment breakthroughs, in order to maintain vision for a longer period of time without repeated laser use. Ire is also a need in the art for new therapies which would be effective for ail types of wet AMD.

SUMMARY OF THE INVENTION

[0013] Methods and compositions for the treatment of wet age-related macular degeneration (wet AMD), choroidal neovascularization (CNV) and wet AMD associated with CNV are provided. The compositions comprise one or more tyrosine kinase inhibitors and are delivered to the suprachoroidal space of the eye via a non-surgical means. In some embodiments the tyrosine kinase inhibitor has activity against vascular endothelial growth factor (VEGF) and/or platelet derived growth factor (PDGF).

[0014] This invention is generally related to ophthalmic therapies, and more particularly to methods and devices that allow for infusion of a fluid drug formulation into posterior ocular tissues for targeted, localized treatment, for example, for the treatment of wet AMD, choroidal neovascularization (CNV), wet AMD associated with RVO or wet AMD associated with CNV. In some embodiments, the drug formulation includes a tyrosine kinase inhibitor and is injected into SCS to provide localized drug in the choroid and retina. In a further embodiment, the tyrosine kinase inhibitor has activity against vascular endothelial growth factor (VEGF) and/or platelet derived growth factor (PDGF). In even a further embodiment, the tyrosine kinase inhibitor is axitinib.

[0015] In one embodiment of the method for treating wet AMD, choroidal neovascularization (CNV) and/or the method for treating wet AMD associated with CNV, subsequent to at least one dosing session, e.g., from about 1 week to about 14 weeks after at least one dosing dession, e.g., about 12 weeks after a dosing session, the patient experiences an improvement in visual acuity as measured by best corrected visual acuity of≥ 10 letters,≥ 15 letters or≥ 25 letters, as compared to patient's visual acuity prior to the at least one dosing session. In one embodiment of the method for treating wet AMD with a tyrosine kinase inhibitor, subsequent to at least one dosing session, e.g., from about 1 week to about 14 weeks after at least one dosing dession, e.g., about 4 weeks, about 8 weeks or about 12 weeks after at least one dosing session, the patient experiences a decrease in retinal thickness (e.g., central subfield thickness) as compared to the patient' s retinal thickness prior to the at least one dosing session. In one embodiment, the decrease in retinal thickness is≥ 25 μm,≥ 50 μm,≥ 75 μm or ≥ 100 μm.Ιn some embodiments, the methods set forth herein are carried out by inserting a distal end portion of a needle of a medical injector into a target tissue to define a delivery passageway within the target tissue and such that a distal end surface of a hub of the medical injector is in contact with a target surface of the target tissue. A force is exerted (e.g., a manual force by a user) on an actuator of the medical injector when the distal end surface of the hub is in contact with the target surface. The medical injector is configured such that the force is sufficient to move a distal end portion of the actuator within the medicament container when the distal end portion of the needle is disposed within a first region of the target tissue. The medical injector is configured such that the force is insufficient to move the distal end portion of the actuator within the medicament container when the distal end portion of the needle is disposed within a second region of the target tissue. In some embodiments, the force has a magnitude of less than about 6 N. A substance, e.g., a drug formulation, in response to the exertion, is conveyed from the medicament container into the target tissue via the needle when the distal end portion of the needle is disposed within the first region of the target tissue. The first region can be, for example, a suprachoroidal space of the eye, a lower portion of the sclera and/or an upper portion of the choroid. In some embodiments, the first region can be a retina of the eye.

[0016] In some embodiments of the methods provided herein, a distal end portion of a needle of a medical injector is inserted into a target tissue to define a delivery passageway within the target tissue. The insertion is performed such that a centerline of the needle and a surface line tangent to a target surface of the target tissue define an angle of entry of between about 75 degrees and about 105 degrees. A distal end surface of a hub of the medical injector is placed into contact with a target surface of the target tissue to fluidically isolate the delivery passageway. After the distal end surface of the hub is placed into contact with the target surface, a substance, e.g., drug formulation, is conveyed into the target tissue via the needle.

[0017] In some embodiments, a distal end portion of a needle of a medical injector is inserted into an eye to define a delivery passageway within a sclera of the eye. After the distal end portion of the needle is inserted into the eye, a force (e.g., a manual force by a user) is applied to the medical injector when a distal tip of the needle is disposed within at least one of a suprachoroidal space or a lower portion of the sclera, the force being insufficient to convey the substance from the medicament container via the needle when the distal tip of the needle is disposed within an upper portion of the sclera of the eye.

[0018] In some embodiments, a method of treating wet age-related macular degeneration (AMD) in a human subject in need thereof is provided herein. In some embodiments, the method includes, in a dosing session, non-surgically administering an effective amount of a tyrosine kinase inhibitor to the suprachoroidal space (SCS) of the eye of the human subject in need of treatment of the wet AMD. Upon administration, the tyrosine kinase inhibitor flows away from the insertion site and is substantially localized to the posterior segment of the eye. In a further embodiment, a VEGF inhibitor is administered to the patient intravitreally.

[0019] In some embodiments, the present disclosure provides formulations comprising axitinib. In some embodiments, the axitinib is Form IX axitinib. In further embodiments, the present disclosure provides formulations comprising axitinib and Polysorbate 80. In further embodiments, the present disclosure provides formulations comprising carboxymethylcellulose sodium, Polysorbate 80, sodium chloride, and sodium phosphate. In further embodiments, the formulation comprises Polysorbate 80 at a w/v of about 0.025% to about 0.2%. In some embodiments, the Polysorbate 80 is present in the formulation at an amount of about 0.05% to about 0.1%). In some embodiments, the Polysorbate 80 is present in the formulation at an amount of about 0.05%) or about 0.1%>. In some embodiments, the formulation comprises about 0.04% w/v to about 0.07%) w/v sodium phosphate (monobasic monohydrate) In further embodiments, the formulation comprises about 0.05%> w/v to about 0.06%> w/v sodium phosphate (monobasic monohydrate). In some embodiments, the formulation comprises about 0.059%) w/v sodium phosphate (monobasic monohydrate). In some embodiments, the formulation comprises about 0.05%) w/v to about 0.09% w/v sodium phosphate (dibasic, anhydrous). In further embodiments, the formulation comprises about 0.06%> w/v to about 0.08%> w/v sodium phosphate (dibasic, anhydrous). In some embodiments, the formulation comprises about 0.079%) w/v sodium phosphate (dibasic, anhydrous). In some embodiments, the formulation comprises about 0.5% w/v to about 1.0% w/v sodium chloride. In further embodiments, the formulation comprises about 0.7%) w/v to about 0.9% w/v sodium chloride. In some embodiments, the formulation comprises about 0.79% w/v sodium chloride. In some embodiments, the formulation comprises about 0.25% w/v to about 0.75% w/v carboxymethylcellulose sodium. In further embodiments, the formulation comprises about 0.3%> w/v to about 0.7% w/v carboxymethylcellulose sodium. In some embodiments, the formulation comprises about 0.5% w/v carboxymethylcellulose sodiu.

[0020] In some embodiments, the formulation comprises the following components: axitinib, about 0.1%) w/v Polysorbate 80, about 0.059%> w/v sodium phosphate (monobasic monohydrate); about 0.079%) sodium phosphate (dibasic, anhydrous), about 0.79% w/v sodium chloride, about 0.5%) carboxymethylcellulose sodium, and water. In some embodiments, the formulation comprises axitinib particles having a D50 of about 1 μm to about 2 μm. In some embodiments, the formulation comprises axitinib particles having a DO of less than 1 μm. In some embodiments, the formulation comprises axitinib particles having a D90 of about 3 μm to about 5 μm.

BRIEF DESCRIPTION OF THE DRAWINGS

[0021] FIG. 1 is a cross-sectional view of an illustration of the human eye.

[0022] FIG. 2 is a cross-sectional view of a portion of the human eye of FIG. 1 taken along the line 2-2.

[0023] FIGS. 3 and 4 are cross-sectional views of a portion of the human eye of FIG. 1 taken along the line 3-3, illustrating the suprachoroidal space without and with, respectively, the presence of a fluid.

[0024] FIG. 5 is a perspective view of a medical injector according to an embodiment.

[0025] FIG. 6 is a partially exploded view of the medical injector of FIG. 5.

[0026] FIG. 7 is an exploded view of the medical injector of FIG. 5, shown without a needle cap.

[0027] FIG. 8 is a front view of a handle included in the medical injector of FIG. 5.

[0028] FIG. 9 is a cross-sectional view of the handle of FIG. 8 taken along the line 9-9. [0029] FIG 10 is a perspective view of a barrel included in the medical injector of FIG. 5.

[0030] FIG. 11 is an exploded view of a needle hub included in the medical injector of FIG. 5.

[0031] FIG. 12 is a front view of the needle hub of FIG. 9.

[0032] FIG. 13 is an enlarged view of a portion of the needle hub of FIG. 12, identified by the region Z₁.

[0033] FIG. 14 is a rear perspective view of a needle cap included in the medical injector of FIG. 5.

[0034] FIG. 15 is a front view of the medical injector of FIG. 5.

[0035] FIG. 16 is a cross-sectional view of the medical injector of FIG. 5, taken along the like 16-16 in FIG. 15.

[0036] FIG. 17 is a view of the medical injector of FIG. 5 in use during an injection procedure into the human eye.

[0037] FIG. 18 is an enlarged view of a portion of the medical injector of FIG. 5 and the human eye, identified in FIG. 17 by the region Z₂.

[0038] FIG. 19 is an exploded view of a needle hub configured for use with the medical injector of FIG. 5, according to an embodiment.

[0039] FIG. 20 is a front view of the needle hub of FIG. 19.

[0040] FIG. 21 is a flowchart illustrating a method of using a medical injector to inject a medicament into an eye.

[0041] FIG. 22 shows the mean (±SD) CLSOl 1 A concentrations (ng/g or ng/mL) in select ocular tissues in male Dutch Belted rabbits dosed via suprachoroidal injection with CLSOl 1 A.

[0042] FIG. 23 shows ocular distribution of 4 mg CLSOl 1 A in rabbits after SCS administration. [0043] FIG. 24 shows axitinib amounts in sclera-chorid-retina following SCS or IVT administration of the drug. ≥70% of axitinib is still present in sclera-chorid-retina 1 week post SCS administration.

[0044] FIG. 25 shows axitinib amounts in vitreous following SCS or IVT administration of the drug.

[0045] FIG. 26 shows total axitinib in the eye following SCS or IVT administration of the drug.

[0046] FIG. 27 shows total percentage of axitinib in the eye following SCS or IVT administration of the drug.

[0047] FIG. 28 shows axitinib amounts in plasma following SCS or IVT administration of the drug.

[0048] FIG. 29 shows total axitinib in the eye following SCS or IVT administration of the drug.

[0049] FIG. 30 shows total percentage of axitinib in the eye following SCS or IVT administration of the drug.

[0050] FIG. 31 shows individual values for vitreous amounts after SCS injection.

[0051] FIG. 32 shows the axitinib drug product particle size distribution. The particles had a D10 of less than 1 μm; a D50 of about 1 μm to about 2 μm; and a D90 of about 3 μm to about 5 μm.

DETAILED DESCRIPTION OF THE INVENTION

[0052] Methods and drug formulations are provided herein for wet macular degeneration (wet AMD) in human subjects in need thereof. In some embodiments, the formulations comprise one or more tyrosine kinase inhibitors and are administered to the suprachoroidal space (SCS) of the eye via a non-surgical means, for example via a hollow microneedle.. The methods and formulations provided herein allow for effective posterior segment drug delivery, and generally embody the following characteristics: (1) the methods are non-surgical and thus minimally invasive and safe; (2) the drug formulations are administered in such a way that they are well targeted to the posterior segment of the eye and/or the suprachoroidal space (SCS) of the eye while simultaneously limiting drug exposure to the anterior segment or other regions of the eye; (3) the methods and formulations are capable of delivering drug in a sustained and/or controlled manner; (4) the methods and devices are user-friendly. The non-surgical SCS delivery methods and drug formulations for SCS delivery set forth herein achieve these desired characteristics.

[0053] The term "suprachoroidal space," is used interchangeably with suprachoroidal, SCS, suprachoroid and suprachoroid! a, and describes the potential space in the region of the eye disposed between the sclera and choroid. This region primarily is composed of closely packed layers of long pigmented processes derived from each of the two adjacent tissues; however, a space can develop in this region as a result of fluid or other material buildup in the suprachoroidal space and the adjacent tissues. Those skilled in the art will appreciate that the suprachoroidal space frequently is expanded by fluid buildup because of some disease state in the eye or as a result of some trauma or surgical intervention. In the present description, however, the fluid buildup is intentionally created by infusion of a drug formulation into the suprachoroid to create the suprachoroidal space (which is filled with drug formulation). Not wishing to be bound by theory, it is believed that the SCS region serves as a pathway for uveoscleral outflow (i.e., a natural process of the eye moving fluid from one region of the eye to the other through) and becomes a real space in instances of choroidal detachment from the sclera.

[0054] As used herein, "ocular tissue" and "eye" include both the anterior segment of the eye (i.e., the portion of the eye in front of the lens) and the posterior segment of the eye (i.e., the portion of the eye behind the lens). For reference, FIGS. 1-4 are a various views of a human eye 10 (with FIGS. 2-4 being cross-sectional views). While specific regions are identified, those skilled in the art will recognize that the proceeding identified regions do not constitute the entirety of the eye 10, rather the identified regions are presented as a simplified example suitable for the discussion of the embodiments herein. The eye 10 includes both an anterior segment 12 (the portion of the eye in front of and including the lens) and a posterior segment 14 (the portion of the eye behind the lens). The anterior segment 12 is bounded by the cornea 16 and the lens 18, while the posterior segment 14 is bounded by the sclera 20 and the lens 18. The anterior segment 12 is further subdivided into the anterior chamber 22, between the iris 24 and the cornea 16, and the posterior chamber 26, between the lens 18 and the iris 24. The cornea 16 and the sclera 20 collectively form a limbus 38 at the point at which they meet. The exposed portion of the sclera 20 on the anterior segment 12 of the eye is protected by a clear membrane referred to as the conjunctiva 45 (see e.g., FIGS. 2 and 3). Underlying the sclera 20 is the choroid 28 and the retina 27, collectively referred to as retinachoroidal tissue. A vitreous humour 30 (also referred to as the "vitreous") is disposed between a ciliary body 32 (including a ciliary muscle and a ciliary process) and the retina 27. The anterior portion of the retina 27 forms an ora serrata 34. The loose connective tissue, or potential space, between the choroid 28 and the sclera 20 is referred to as the suprachoroid. FIG. 2 illustrates the cornea 16, which is composed of the epithelium 40, the Bowman's layer 41, the stroma 42, the Descemet's membrane 43, and the endothelium 44. FIG. 3 illustrates the sclera 20 with surrounding Tenon's Capsule 46 or conjunctiva 45, suprachoroidal space 36, choroid 28, and retina 27, substantially without fluid and/or tissue separation in the suprachoroidal space 36 (i.e., the in this configuration, the space is "potential" suprachoroidal space). As shown in FIG. 3, the sclera 20 has a thickness between about 500 μm and 700 μm. FIG. 4 illustrates the sclera 20 with the surrounding Tenon's Capsule 46 or the conjunctiva 45, suprachoroidal space 36, choroid 28, and retina 27, with fluid 50 in the suprachoroidal space 36.

[0055] The dashed line in FIG. 1 represents the equator of the eye 10. In some embodiments, the insertion site of any of the microneedles and/or methods described herein is between the equator and the limbus 38 (i.e., in the anterior portion 12 of the eye 10) For example, in some embodiments, the insertion site is between about two millimeters and 10 millimeters (mm) posterior to the limbus 38. In other embodiments, the insertion site of the microneedle is at about the equator of the eye 10. In still other embodiments, the insertion site is posterior the equator of the eye 10. In this manner, a drug formulation can be introduced (e.g., via the microneedle) into the suprachoroidal space 36 at the site of the insertion and can flow through the suprachoroidal space 36 away from the site of insertion during an infusion event (e.g., during injection).

[0056] The microneedle may extend from the base of the microneedle device at any angle suitable for insertion into the eye 10. In a particular embodiment, the microneedle extends from the base at an angle of about 90 degrees to provide approximately perpendicular insertion of the microneedle into the surface of the eye. In another embodiment, the microneedle extends from the base at an angle from about 60 to about 1 10 degrees, from about 70 degrees to about 100 degrees, from about 80 degrees to about 90 degrees, or from about 85 degrees to about 95 degrees.

[0057] The microneedle device may comprise a means for controllably inserting, and optionally retracting, the microneedle into the ocular tissue. In addition, the microneedle device may include means of controlling the angle at which the at least one microneedle is inserted into the ocular tissue (e.g., by inserting the at least one microneedle into the surface of the ocular tissue at an angle of about 90 degrees).

[0058] In one embodiment, the depth of microneedle insertion into the ocular tissue can be controlled by the length of the microneedle, as well as other geometric features of the microneedle. For example, a flange or other a sudden change in microneedle width can be used to limit the depth of microneedle insertion. The microneedle insertion can also be controlled using a mechanical micropositioning system involving gears or other mechanical components that move the microneedle into the ocular tissue a controlled distance and, likewise, can be operated, for example, in reverse, to retract the microneedle a controlled distance. The depth of insertion can also be controlled by the velocity at which the microneedle is inserted into the ocular tissue. The retraction distance can be controlled by elastic recoil of the ocular tissue into which the microneedle is inserted or by including an elastic element within the microneedle device that pulls the microneedle back a specified distance after the force of insertion is released.

[0059] The angle of insertion can be directed by positioning the microneedle at a first angle relative to the microneedle base and positioning the base at a second angle relative to the ocular surface. In one embodiment, the first angle can be about 90° and the second angle can be about 0°. The angle of insertion can also be directed by having the microneedle protrude from a device housing through a channel in that housing that is oriented at a specified angle.

[0060] As provided throughout, in one embodiment, the methods described herein are carried out with a hollow or solid microneedle, for example, a rigid microneedle. As used herein, the term "microneedle" refers to a conduit body having a base, a shaft, and a tip end suitable for insertion into the sclera and other ocular tissue and has dimensions suitable for minimally invasive insertion and drug formulation infusion as described herein. That is, the microneedle has a length or effective length that does not exceed about 2000 microns and a diameter that does not exceed about 600 microns. Both the "length" and "effective length" of the microneedle encompass the length of the shaft of the microneedle and the bevel height of the microneedle. In some embodiments, the microneedle used to carry out the methods described herein comprises one of the devices disclosed in International Patent Application Publication No. WO2014/179698 (Application No. PCT/US2014/036590), filed May 2, 2014 and entitled "Apparatus and Method for Ocular Injection," incorporated by reference herein in its entirety for all purposes. In some embodiments, the microneedle used to carry out the methods described herein comprises one of the devices disclosed in International Patent Application Publication No. WO2014/036009 (Application No. PCT/US2013/056863), filed August 27, 2013 and entitled "Apparatus and Method for Drug Delivery Using Microneedles," incorporated by reference herein in its entirety for all purposes.

[0061] In another embodiment, the microneedle is designed to have a length longer than the desired penetration depth, but the microneedle is controllably inserted only part way into the tissue. Partial insertion may be controlled by the mechanical properties of the tissue, which bends and dimples during the microneedle insertion process. In this way, as a microneedle is inserted into the tissue, its movement partially elastically deforms the tissue and partially penetrates into the tissue. By controlling the degree to which the tissue deforms, the depth of microneedle insertion into the tissue can be controlled.

[0062] In one embodiment, the device used to carry out one of the methods described herein comprises the device described in U.S. Design Patent Application Serial No. 29/506,275 entitled, "Medical Injector for Ocular Injection," filed October 14, 2014, the disclosure of which is incorporated herein by reference in its entirety for all purposes.

[0063] In one embodiment, the microneedle is inserted into the eye of the human patient using a rotational/drilling technique and/or a vibrating action. In this way, the microneedle can be inserted to a desired depth by, for example, drilling the microneedles a desired number of rotations, which corresponds to a desired depth into the tissue. See, e.g., U.S. Patent Application Publication No. 2005/0137525, which is incorporated herein by reference, for a description of drilling microneedles. The rotational/drilling technique and/or a vibrating action may be applied during the insertion step, retraction step, or both.

[0064] As used herein, the words "proximal" and "distal" refer to the direction closer to and away from, respectively, an operator (e.g., surgeon, physician, nurse, technician, etc.) who would insert the medical device into the patient, with the tip-end (i.e., distal end) of the device inserted inside a patient's body first. Thus, for example, the end of a microneedle described herein first inserted inside the patient's body would be the distal end, while the opposite end of the microneedle (e.g., the end of the medical device being manipulated by the operator) would be the proximal end of the microneedle.

[0065] As used herein, the terms "about" and "approximately" generally mean plus or minus 10% of the value stated. For example, about 0.5 would include 0.45 and 0.55, about 10 would include 9 to 11, about 1000 would include 900 to 1100.

[0066] The term "fluid-tight" is understood to encompass both a hermetic seal (i.e., a seal that is gas-impervious) as well as a seal that is only liquid-impervious. The term "substantially" when used in connection with "fluid-tight," "gas-impervious," and/or "liquid-impervious" is intended to convey that, while total fluid imperviousness is desirable, some minimal leakage due to manufacturing tolerances, or other practical considerations (such as, for example, the pressure applied to the seal and/or within the fluid), can occur even in a "substantially fluid-tight" seal. Thus, a "substantially fluid-tight" seal includes a seal that prevents the passage of a fluid (including gases, liquids and/or slurries) therethrough when the seal is maintained at a constant position and at fluid pressures of less than about 5 pounds per square inch gage (psig), less than about 10 psig, less than about 20 psig, less than about 30 psig, less than about 50 psig, less than about 75 psig, less than about 100 psig and all values in between. Similarly, a "substantially liquid-tight" seal includes a seal that prevents the passage of a liquid (e.g., a liquid medicament) therethrough when the seal is maintained at a constant position and is exposed to liquid pressures of less than about 5 psig, less than about 10 psig, less than about 20 psig, less than about 30 psig, less than about 50 psig, less than about 75 psig, less than about 100 psig and all values in between. [0067] As used herein, the term "hollow" includes a single, straight bore through the center of the microneedle, as well as multiple bores, bores that follow complex paths through the microneedles, multiple entry and exit points from the bore(s), and intersecting or networks of bores. That is, a hollow microneedle has a structure that includes one or more continuous pathways from the base of the microneedle to an exit point (opening) in the shaft and/or tip portion of the microneedle distal to the base.

[0068] The microneedle device in one embodiment, comprises a fluid reservoir for containing the therapeutic formulation (e.g., drug or cell formulation), e.g., as a solution or suspension, and the drug reservoir (which can include any therapeutic formulation) being in operable communication with the bore of the microneedle at a location distal to the tip end of the microneedle. The fluid reservoir may be integral with the microneedle, integral with the elongated body, or separate from both the microneedle and elongated body.

[0069] The microneedle and/or any of the components included in the embodiments described herein is/are formed and/or constructed of any suitbale biocompatible material or combination of materials, including metals, glasses, semi-conductor materials, ceramics, or polymers. Examples of suitable metals include pharmaceutical grade stainless steel, gold, titanium, nickel, iron, gold, tin, chromium, copper, and alloys thereof. The polymer can be biodegradable or nonbiodegradable. Examples of suitable biocompatible, biodegradable polymers include polylactides, polyglycolides, polylactide-co-glycolides (PLGA), polyanhydrides, polyorthoesters, polyetheresters, polycaprolactones, polyesteramides, poly(butyric acid), poly(valeric acid), polyurethanes and copolymers and blends thereof. Representative non-biodegradable polymers include various thermoplastics or other polymeric structural materials known in the fabrication of medical devices. Examples include nylons, polyesters, polycarbonates, polyacrylates, polymers of ethylene-vinyl acetates and other acyl substituted cellulose acetates, non-degradable polyurethanes, polystyrenes, polyvinyl chloride, polyvinyl fluoride, poly(vinyl imidazole), chlorosulphonate polyolefins, polyethylene oxide, blends and copolymers thereof. Biodegradable microneedles can provide an increased level of safety compared to nonbiodegradable ones, such that they are essentially harmless even if inadvertently broken off into the ocular tissue. [0070] In one embodiment, the hollow microneedle provided herein is fabricated using a laser or similar optical energy source. In one example, a microcannula may be cut using a laser to represent the desired microneedle length. The laser may also be use to shape single or multiple tip openings. Single or multiple cuts may be performed on a single microncannula to shape the desired microneedle structure. In one example, the microcannula may be made of metal such as stainless steel and cut using a laser with a wavelength in the infrared region of the light spectrum (e.g., from about 0.7 to about 300 μm). Further refinement may be performed using metal electropolishing techniques familiar to those in the field. In another embodiment, the microneedle length and optional bevel is formed by a physical grinding process, which for example may include grinding a metal cannula against a moving abrasive surface. The fabrication process may further include precision grinding, micro-bead jet blasting and ultrasonic cleaning to form the shape of the desired precise tip of the microneedle.

[0071] Further details of possible manufacturing techniques are described, for example, in U. S. Patent Application Publication No. 2006/0086689, U. S. Patent Application Publication No. 2006/0084942, U.S. Patent Application Publication No. 2005/0209565, U.S. Patent Application Publication No. 2002/0082543, U. S. Patent No. 6,334,856, U. S. Patent No. 6,61 1,707, U.S. Patent No. 6,743,21 1 and PCT/US2014/36590, filed May 2, 2014, all of which are incorporated herein by reference in their entireties for all purposes.

[0072] In some embodiments, an apparatus includes a medicament container, a piston assembly and a handle. The medicament container defines a lumen configured to contain a medicament. A distal end portion of the medicament container includes a coupling portion configured to be removably coupled to a needle assembly. A proximal end portion of the medicament container includes a flange and a longitudinal shoulder. A distal end portion of the piston assembly includes an elastomeric member movably disposed within the lumen of the medicament container. The handle is coupled to a proximal end portion of the piston assembly such movement of the handle produces movement of the elastomeric member within the medicament container. The proximal end portion of the medicament container is movably disposed within the handle. A portion of the handle is configured to contact the flange to limit proximal movement of the handle relative to the medicament container. The handle includes a protrusion configured to engage the longitudinal shoulder of the medicament container to limit rotation of the handle relative to the medicament container.

[0073] Any of the compositions described herein can be injected using any suitable injector of the types shown and described herein. Any of the methods described herein can be performed use any suitable injector of the types shown and described herein. In this manner, the benefits of targeted drug delivery via a non-surgical approach can be realized. For example, in some embodiments, an apparatus includes a medicament container, a needle assembly, and a piston assembly. The medicament container contains a dose of a medicament, such as, for example a drug or cellular therapeutic, e.g., a steroid formulation or a cell suspension (e.g., a stem cell suspension). The dose has a delivered volume of at least about 20 μL, at least about 50 uL, at least about 100 μL, at least about 200 μL, or at least about 500 μL. In one embodiment, the amount of therapeutic formulation delivered into the suprachoroidal space from the devices described herein is from about 10 μL, to about 200 μL, e.g., from about 50 μL, to about 150 μL. In another embodiment, from about 10 μL, to about 500 μL, e.g., from about 50 μL, to about 250 μί, is non- surgically administered to the suprachoroidal space.

[0074] The needle assembly is coupled to a distal end portion of the medicament container, and includesss a contact surface and a needle. The contact surface is configured to contact a target surface of an eye, and can include a convex surface and/or a sealing portion, as described herein. The needle is coupled to the base. A distal end portion of the piston assembly includes an elastomeric member movably disposed within the medicament container. A proximal end portion of the piston assembly is configured to receive a force to move the elastomeric within the medicament container to deliver the dose of the medicament via the needle assembly. The needle assembly and the piston assembly being collectively configured to deliver the dose of the medicament into the suprachoroidal space of the eye such that an intraocular pressure of the eye measured within 30 minutes after delivery of the dose is within five percent, ten percent, fifteen percent, twenty percent or twenty-five percent of an intraocular pressure of the eye measured before the delivery of the dose.

[0075] In some embodiments, an apparatus includes a medicament container, a needle assembly, and a piston assembly. The medicament container contains a dose of a medicament, such as, for example a steroidal composition such as a triamcinolone composition. The needle assembly is coupled to a distal end portion of the medicament container, and includesss a contact surface and a needle. The contact surface is configured to contact a target surface of an eye, and can include a convex surface and/or a sealing portion, as described herein. The needle is coupled to the base. A distal end portion of the piston assembly includes an elastomeric member movably disposed within the medicament container. A proximal end portion of the piston assembly is configured to receive a force to move the elastomeric within the medicament container to deliver the dose of the medicament via the needle assembly. The needle assembly and the piston assembly being collectively configured to deliver the dose of the medicament into a suprachoroidal space of the eye such that a therapeutic response resulting from the dose is substantially equivalent to a therapeutic response resulting from the delivery of a corresponding dose of the medicament via any one of an intravitreal delivery method, a topical delivery method, a parenteral delivery method or an oral delivery method. An amount of the dose is less than about 75 percent of an amount of the corresponding dose.

[0076] In some embodiments, an apparatus includes a medicament container, a needle assembly, and a piston assembly. The medicament container contains a dose of a medicament, such as, for example a steroidal composition such as a triamcinolone composition. The needle assembly is coupled to a distal end portion of the medicament container, and includesss a contact surface and a needle. The contact surface is configured to contact a target surface of an eye, and can include a convex surface and/or a sealing portion, as described herein. The needle is coupled to the base. A distal end portion of the piston assembly includes an elastomeric member movably disposed within the medicament container. A proximal end portion of the piston assembly is configured to receive a force to move the elastomeric within the medicament container to deliver the dose of the medicament via the needle assembly. The needle assembly and the piston assembly being collectively configured to deliver the dose of the medicament into a suprachoroidal space of the eye such that an intraocular Cmax resulting from the dose is greater, for example at least about 1.25 x, 1.5 x or 2x greater than an intraocular Cmax resulting from the delivery of a corresponding dose of the medicament via any one of an intravitreal delivery method, a topical delivery method, a parenteral delivery method or an oral delivery method. [0077] The needle assembly and the piston assembly being collectively configured to deliver the dose of the medicament into a suprachoroidal space of the eye such that an intraocular AUC resulting from the dose is greater, for example at least about 1.25^χ, 1.5^χ or 2^χ greater than an intraocular AUC resulting from the delivery of a corresponding dose of the medicament via any one of an intravitreal delivery method, a topical delivery method, a parenteral delivery method or an oral delivery method.

[0078] FIGS. 5-18 illustrate a medical injector 100 configured to deliver a medicament to, for example, ocular tissue, according to an embodiment. The medical injector 100 can be used in conjunction with any of the methods and therapeutic formulations described herein. More specifically, the medical injector 100 (also referred to herein as "injector") can have a size, shape, and/or configuration that is based at least in part on constraints and/or challenges associated with delivering a drug formulation into ocular tissue. For example, as described in further detail herein, medicament delivery into ocular tissue using conventional devices and/or needles can lead to incomplete delivery of a dose, reduction in efficacy of an injected medicament, seeding of undersirable cells, trauma, etc. Thus, the medical injector 100 can have a size and/or configuration that effectively deliver a medicament to a portion of the eye such as a posterior region thereof.

[0079] As shown, the medical injector 100 includes a handle 110, a barrel 130, a piston 150, a needle hub 160, and a cap 170. The handle 110 can be any suitable shape, size, and/or configuration. For example, in some embodiments, the handle 110 can have an ergonomic shape and/or size, which can enable to manipulate the injector 100 with one hand or with two hands. The handle 110 has a proximal end portion 111 and a distal end portion 112, and defines an inner volume 113 (see e.g., FIG. 9). The inner volume 113 of the handle 110 receives and/or is configured to house at least a portion of the barrel 130 and the piston 150, as described in further detail herein.

[0080] As shown in FIG. 7-9, the handle 110 is formed by coupling a first handle member 115A to a second handle member 115B. The handle member 115A and the handle member 115B can be relatively thin shelled or the like and can be formed from any suitable material such as the biocompatible materials described above. In other words, the handle members 115A and 1158B can be substantially hollow and/or can define an inner volume (e.g., the inner volume 1 13). The first handle member 1 15A has a proximal end portion 1 16A and a distal end portion 1 17A. Moreover, the first handle member 1 15A has an inner surface 1 18A that can include any suitable feature, cutout, coupler, wall, etc., any of which can be used to facilitate the coupling of the first handle member 1 15A to the second handle member 1 15B and/or to engage a portion of the piston 150 and/or the barrel 130. For example, as shown in FIG. 9, the inner surface 1 18A of the first handle member 1 15A can form a rib 120A, a retention member 1 19A, and at least one coupler 121A, which can be used, iner alia, to engage the barrel 130, the piston 150, and/or the second handle member 1 15B, respectively, as described in further detail herein.

[0081] Similarly, the second handle member 1 15B has a proximal end portion 1 16B and a distal end portion 1 17B. The second handle member 1 15B also has an inner surface 1 18B that forms a rib 120B, a retention member 1 19B, and at least one coupled 121B, which can be used to engage the barrel 130, the piston 150, and the first handle member 1 15A, respectively, as described in further detail herein. As shown in FIG. 9, for example, the first handle member 1 15A and the second handle member 1 15B are coupled together to collectively form the handle 100. The first handle member 1 15A and the second handle member 1 15B can be coupled in any suitable member. For example, in some embodiments, the retention member 1 19B of the second handle member 1 15B can define an opening or the like configured to matingly receive a portion of the retention member 1 19A of the first handle member 1 15A. Similarly, the at least one coupler 121B of the second handle member 1 19B can define an opening configured to matingly receive a portion of an associated coupler 121 A of the first handle member 1 15A. In some embodiments, the retention member 1 19A and the coupler(s) 121B of the first handle member 1 15A can be configured to form a press or friction fit with an inner surface of the retention member 1 19B and the coupler(s) 121B of the second handle member 1 15B, which can be operable in coupling the first handle member 1 15A to the second handle member 1 15B. In other embodiments, the first handle member 1 15A and the second handle member 1 15B can be coupled via any suitable method such as, for example, an adhesive, an ultrasonic weld, a mechanical fastener, and/or the like. Furthermore, when the first handle member 1 15A is coupled to the second handle member 1 15B, the inner surfaces 1 18A and 1 18B of the handle members 1 15A and 1 15B, respectively, collectively define the inner volume 1 13 of the handle 1 10, as shown in FIG. 9. [0082] The barrel 130 of the injector 100 can be any suitable shape, size, or configuration. As shown in FIG. 10, the barrel 130 has a proximal end portion 131 and a distal end portion 132 and defines a lumen 133 therethrough. In addition, the barrel 130 has an outer surface that defines a set of slots 136 (only one is shown in FIG. 10) and a grip portion 137. The grip portion 137 can be configured to facilitate the use of the device by providing a user with a predetermined location to engage the injector 100. The grip portion 137 can have any suitable surface finish or the like, which can, in some instances, increase a friction between the grip portion 137 and a user's fingers and/or hand. In other embodiments, the barrel 130 does not include a grip portion.

[0083] The lumen 133 of the barrel 130 movably receives at least a portion of the piston 150, as described in further detail herein. Moreover, at least a portion of the lumen 133 can define a medicament volume configured to receive, store, house, and/or otherwise contain a medicament (e.g., a corticosteroid such as triamcinolone acetonide, or any other medicament described herein). In some embodiments, at least a portion of the barrel 130 can be substantially transparent and/or can include an indicator or the like configured to allow a user to visually inspect a volume of fluid (e.g., medicament/therapeutic formulation) within the lumen 133. In some instances, such an indicator can be, for example, any number of lines and/or markings associated with a volume of fluid disposed within the barrel 130. In other embodiments, the barrel 130 can be substantially opaque and/or does not include an indicator or the like.

[0084] The distal end portion 132 includes and/or forms a coupler 138 configured to be physically and fluidically coupled to the needle hub 160, as described in further detail herein. The proximal end portion 131 of the barrel 130 includes a flanged end 135 and defines a set of slots 136 (only one slot is shown in FIG. 10). As described above, at least a portion of the barrel 130 is disposed within the inner volume 113 of the handle 110 (see, e.g., FIG. 16). Specifically, at least the proximal end portion 131 of the barrel 130 can be inserted into the handle 110 in such a manner that the handle 110 can be moved relative to the barrel 130. In other words, at least the proximal end portion 131 of the barrel 130 can be movably disposed within the inner volume 113 defined by the handle 110. Moreover, when the proximal end portion 131 of the barrel 130 is disposed in the handle 110, the ribs 120A and 120B of the handle members 115A and 115B, respectively, are movably disposed in its associated slot 136 defined by the barrel 130. Such an arrangement can, for example, define a range of motion of the handle 1 10 relative to the barrel 130. Such an arrangement can also limit a rotational motion of the handle 110 about the barrel 130 while allowing a translational motion of the handle 110 relative to the barrel 130 in a proximal or a distal direction. In this manner, during the injection operation, substantially all of the force applied by the user will urge the handle 110 (and therefore the piston 150) in the distal direction, and will not cause rotation of the piston 150 within the barrel 130. By limiting the rotational motion of the piston 150 (and particularly, the elastomeric member 155) within the barrel 130, the injection operation can be consistently performed. For example, by limiting the rotational motion of the elastomeric member 155 within the barrel 130, the force needed to overcome the static coefficient of friction between the elastomeric member 155 and the barrel 130 will be more consistent (between parts andor injection) than if an applied force includes both translational (i.e., distal) and rotational components. This arrangement facilitates a more consistent "loss of resistance" felt at the handle 110 during an injection operation, as described below.

[0085] Additionally, the arrangement of the flanged end 135 of the barrel 130 and the inner surfaces 118A and 118B of the handle members 115A and 115B, respectively, can define a translational range of motion of the handle 110 relative to the barrel 130 in the proximal or the distal direction (see e.g., FIG. 16).

[0086] The piston 150 of the injector 100 can be any suitable shape, size, and/or configuration. For example, referring back to FIG. 7, the pison 150 can have a size and shape that are each associated with the handle 110 and/or the barrel 130, which in turn, can allow at least a portion of the piston 150 to be disposed within the handle 110 and/or the barrel 130. More specifically, the piston 150 has a proximal end portion 151 and a distal end portion 152. The proximal end portion 151 of the piston 150 is configured to be disposed within the inner volume 113 of the handle 110. As shown in FIG. 7, the proximal end portion 151 of the piston 150 includes a tab 153 or the like that defines an opening 154, which in turn, can receive at least a portion of the retention members 119A and 119B of the handle members 115A and 115B, respectively. For example, in some embodiments, during an assembly and/or manufacturing process and prior to coupling the handle members 115A and 115B, the proximal end portion 151 of the piston 150 can be positioned relative to the retention member 119B of the second handle member 115B such that at least a portion of the retention member 119B is disposed within the opening 154 defined by the piston 150. In other words, the tab 153 at or near the proximal end portion 151 of the piston 150 can be disposed about a portion of the retention member 119B prior to coupling the first handle member 115A to the second handle member 115B. As such, the piston 150 can be fixedly coupled to the handle 110.

[0087] The distal end portion 152 of the piston 150 is configured to be movably disposed in the lumen 133 of the barrel 130. As shown in FIG. 7, the distal end portion 152 of the piston 150 includes and/or is coupled to an elastomeric member 155. In some embodiments, the elastomeric member 155 can be monolithically formed with the piston 150 (e.g., overmolded or the like). In other embodiments, the elastomeric member 155 can be formed independently of the piston 150 and coupled thereto. The elastomeric member 155 can be made of an inert and/or biocompatible material, which can have any suitable hardness and/or durometer. For example, in some embodiments, the elastomeric member 155 can be formed from and/or constructed out of a rubber, silicone, plastic, nylon, polymers, any other suitable material or combination thereof. In some embodiments, at least a portion of the elastomeric member 155 can be configured to deform or the like while substantially maintaining its original shape. That is to say, the elastomeric member 155 can have a durometer that is sufficiently low to allow at least some deformation thereof, while preventing the elastomeric member 155 from being substantially reconfigured and/or the like.

[0088] The elastomeric member 155 can be disposed in the lumen 113 such that an outer surface of the elastomeric member 155 is in contact with an inner surface of the barrel 130 defining the lumen 133. In some embodiments, the elastomeric member 155 and the inner surface of the barrel 130 collectively form a substantially fluid-tight seal and/or a hermetic seal, which can, for example, prevent leakage, out gassing, contamination, and/or the like of a substance (e.g., a medicament) disposed within the barrel 130. Moreover, the elastomeric member 155 can have a size, shape and/or can be constructed from a material such that movement of the piston 150 and/or elastomeric member 155 within the barrel 130 is limited when a force applied is below a predetermined threshold. In this manner, the piston 150 can be maintained in a substantially fixed position relative to the barrel 130 until a force exerted, for example, on the handle 110 is sufficient to inject a medicament into a target tissue, as described in further detail herein. In some embodiments, the size, shape, and/or configuration of the elastomeric member 155 can be changed to, for example, increase or decrease an amount of force used to move the piston 150 within the barrel 130, which in some instances, can be based on one ore more characteristics associated with a target tissue and/or the like, as described in further detail herein.

[0089] The needle hub 160 of the injector 100 can be any suitable shape, size, and/or configuration. As shown in FIGS. 11-13, 15, and 16, the needle hub 160 has a proximal end portion 161, a distal end portion 162, an indicator portion 168, and a pair of tabs 164, and defines a lumen 167 (see e.g., FIG. 16). The proximal end portion 161 of the needle hub 160 is configured to be coupled to the distal end portion 132 of the barrel 130. For example, the needle hub 160 can include a coupler 163 (see e.g., FIG. 16) that can matingly engage the coupler 138 of the barrel 130 to couple the needle hub 160 to the barrel 130 and to place the lumen 167 of the needle hub 160 in fluid communication with the lumen 133 of the barrel 130. In some embodiments, the coupler 163 of the needle hub 160 and the coupler 138 of the barrel 130 can form a threaded coupling or the like. In such embodiments, a user can, for example, engage the tabs 164 to rotate the needle hub 160 relative to the barrel 130, thereby threading the coupler 163 of the needle hub 160 onto the coupler 138 of the barrel 130. In some embodiments, the coupler 163 of the needle hub 160 can be a locking mechanism and/or the like such as, for example, a Luer-Lok® (or other locking mechanism) configured to form a fluid tight seal with the distal end portion 132 of the barrel 130 when coupled thereto. The distal end portion 162 of the needle hub 160 includes and/or is coupled to a base 165, which in turn, is coupled to and/or forms a microneedle 166, as described below. The indicator portion 168 of the needle hub 160 is configured to provide a visual indication associated with one or more characteristics of the microneedle 166. For example, in this embodiment, the indicator portion 168 can be configured to provide a visual indication associated with an effective length of the microneedle 166 (e.g., "900" micrometers, as shown in FIG. 12).

[0090] The base 165 can be any suitable shape, size, and/or configuration and can be configured to contact a portion of the ocular tissue during an injection event. For example, as shown, the base 165 has a convex distal end surface, which is configured to contact a target surface of a target tissue when a substance is conveyed through the needle into the target tissue (see, e.g., FIG. 18). In some embodiments, the distal end surface includes a sealing portion (not identified in the FIGS.) configured to define a substantially fluid-tight seal with the target surface when the distal end surface is in contact with the target surface. For example, the distal end surface of the base 165 can deform the target surface such that the sealing portion is contiguous with the target surface and forms the substantially fluid-tight seal. In some embodiments, the sealing portion can be symmetrical about the microneedle 166.

[0091] In some embodiments, the base 165 can be formed from a material or combination of materials that is/are relatively flexible and/or that has/have a relatively low durometer. In some instances, the base 165 can be formed from a material with a durometer that is sufficiently low to limit and/or prevent damage to the ocular tissue when placed in contact therewith. In some instances, the base 165 can be configured to deform (e.g., elastically or plastically) when placed in contact with the ocular tissue. In other embodiments, the base 165 can be formed from a material of sufficient hardness such that the target tissue (and not the base) is deformed when the base 165 is placed in contact with and/or pressed against the target tissue. In some embodiments, for example, the base 165 is constructed from a medical grade stainless steel, and has a surface finish of less than about 1.6 μm Ra. In this manner, the surface finish can facilitate the formation of a substantially fluid-tight seal between the base 165 and the target tissue.

[0092] Furthermore, when the base 165 is coupled to the needle hub 160, a lumen 169 defined by the microneedle 166 is in fluid communication with the lumen 167 of the needle hub 160 (see, e.g., FIG. 16). Thus, a substance can flow through the lumen 167 of the needle hub 160 and the lumen 169 of the microneedle 166 to be injected into a target tissue, as described in further detail herein.

[0093] The microneedle 166 can be any suitable device or structure that is configured to puncture a target tissue of a patient. For example, the microneedle 166 can be any of the microneedles described herein configured to puncture ocular tissue. In some embodiments, the microneedle 166 can be a 30 gauge microneedle, a 32 gauge microneedle or a 34 gauge microneedle. As shown in FIG. 13, the microneedle 166 extends from a distal surface of the base 165 by a distance Di (also referred to herein as an "effective length"). In some embodiments, the shape and/or size of the microneedle 166 can correspond with at least a portion of a target tissue. For example, in some embodiments, the effective length of the microneedle 166 (e.g., the portion of the microneedle 166 that is outside or distal to the base 165) can correspond with a portion of ocular tissue such that when the microneedle 166 is inserted into the ocular tissue, a portion of the microneedle 166 is disposed within the sclera or suprachoroidal space of the eye. Specifically, in this embodiment, the effective length and/or the distance Di is about 900 micrometers (μm). Moreover, the indicator portion 168 of the needle hub 160 can be configured to provide a user with a visual indication associated the effective length and/or distance D₁. Although not shown in FIGS. 11-13, in some embodiments, the microneedle 166 can have a bevel geometry (e.g., bevel angle, bevel height, bevel aspect ratio or the like), which can facilitate the piercing and/or insertion of a tip of the microneedle 166 into the target tissue and the opening (not shown) of the microneedle 166 can be maintained within a desired region during an injection event. In some embodiments, the microneedle 166 or any of the microneedles described herein can include a bevel or other characteristics of the types shown and described in International Patent Application Publication No. WO2014/036009 (Application No. PCT/US2013/056863), filed August 27, 2013 and entitled "Apparatus and Method for Drug Delivery Using Microneedles" and/or International Patent Application Publication No. WO2014/179698 (International Application No. PCT/US2014/036590), filed May 2, 2014 and entitled "Apparatus and Method for Ocular Injection," each of which is incorporated by reference herein in its entirety for all purposes.

[0094] As described above, the base 165 can be coupled to the needle hub 160, which in turn, is coupled to the barrel 130 such that the lumen 133 of the barrel, the lumen 167 of the needle hub 160, and the lumen 169 of the microneedle 166 define a fluid flow path through which a medicament and/or substance contained within the barrel 130 can flow, for example, to be injected into a target tissue.

[0095] The cap 170 of the injector 100 is removably disposed adjacent to a distal end portion 132 of the barrel 130 and is configured to substantially house, cover, enclose, protect, isolate, etc. at least a portion of the needle hub 160. More specifically, the cap 170 can be moved relative to the remaining portions of the medical injector 100 to position at least a portion of the needle hub 160 within an inner volume 174 (see, e.g., FIG. 14) of the cap 170. As such, the cap 170 can have a size and/or shape that is associated with and/or at least partially based on a size and/or shape of the needle hub 160. In some embodiments, the cap 170 and a portion of the needle hub 160 can collectively define a friction fit or the like, which can be operable in maintaining the cap 170 in a substantially fixed position relative to the needle hub 160. In addition, in some embodiments, the cap 170 and the portion of the needle hub 160 can collectively form a substantially fluid tight and/or substantially hermetic seal, which in turn, can maintain the sterility of a microneedle 166 prior to use of the medicament delivery device 100. For example, although not shown, the cap 170 can include a plug, a seal, a sterilization member (e.g., wipe, pad, etc.), and/or the like configured to maintainen the sterility of the microneedle 166 prior to use. Moreover, as shown in FIG. 14, the cap 170 includes an indicator portion 173 that can provide a visual indication to a user associated with a size and/or effective length of the microneedle 166. In some embodiments, the indicator portion 173 can be substantially similar in form and function to the indicator portion 168 of the needle hub 160 and can be configured to provide substantially the same visual indication.

[0096] As shown in FIGS. 15-18, in some instances, a user (e.g., a doctor, technician, nurse, physician, ophthalmologist, etc.) can manipulate the injector 100 to deliver a drug formulation to the suprachoroidal space of an eye according to an embodiment. In some instance, prior to an injection event, the user can, for example, couple the distal end portion 132 of the barrel 130 to a fluid reservoir or the like and/or any suitable transfer device (not shown) to transfer a volume of a medicament and/or drug formulation into the lumen of the barrel 130. For example, in some embodiments, the distal end portion 132 of the barrel 130 can be physically and fluidically coupled to a transfer adapter and/or the like having a puncture member configured to puncture a fluid reservoir containing a drug formulation such as those described herein. Such transfer adapters can be similar to the adapter 21280 shown and described in International Patent Application Publication No. WO2014/179698 (Application No. PCT/US2014/036590), filed May 2, 2014 and entitled "Apparatus and Method for Ocular Injection," incorporated by reference herein in its entirety for all purposes. As such, the puncture member places the transfer adapter in fluid communication with the fluid reservoir. With the transfer adapter physically and fluidically coupled to the barrel 130, the transfer adapter similarly places the lumen 133 of the barrel 130 in fluid communication with the fluid reservoir.

[0097] With the barrel 130 in fluid communication with the fluid reservoir (not shown), the user can manipulate the injector 100 by moving the handle 1 10 relative to the barrel 130 in the proximal direction, which in turn, moves the piston 150 disposed within the lumen 133 of the barrel 130 in the proximal direction. As such, a volume associated with a portion of the lumen 133 defined by the barrel 130 distal to the elastomeric member 155 of the piston 150 increases and a volume associated with a portion of the lumen 133 proximal to the elastomeric member 155 decreases. In some embodiments, the friction fit and/or fluidic seal defined between the elastomeric member 155 and the inner surface of the barrel 130 can be such that the proximal movement of the piston 150 (e.g., the increase in volume of the portion of the lumen 133 distal to the elastomeric member 155) produces a negative pressure differential within the portion of the lumen 133, which can be operable in drawing a volume of the medicament and/or the drug formulation from the fluid reservoir and into the portion of the lumen 133 distal to the elastomeric member 155 (e.g., a medicament volume). In some embodiments, a predetermined volume of the drug formulation can be drawn into the lumen 133 of the barrel 130. In other embodiments, the volume of the drug formulation drawn into the lumen 133 is not predetermined. With the desired amount of drug formulation contained in the barrel 130, the user can, for example, decouple the barrel 130 from the transfer adapter (not shown). Moreover, in some embodiments, the coupler 138 and/or the distal end portion 132 of the barrel 130 can include a self-sealing port and/or any other suitable port configured to fluidically isolate the lumen 133 of the barrel 130 from a volume outside of the barrel 130. Although described above as transferring a volume of the drug formation from the fluid reservoir and into the lumen 133 of the barrel 130, in other embodiments, the injector 100 can be prefilled during, for example, a manufacturing process and/or any other time prior to use.

[0098] In some instances, with the desired amount of the drug formulation contained in the barrel 130, the user can manipulate the injector 100 to couple the needle hub 160 (e.g., disposed within the cap 170 or not disposed within the cap 170) to the distal end portion 132 of the barrel 130, thereby placing the lumen 169 of the microneedle 166 in fluid communication with the lumen 133 of the barrel 130. With the needle hub 160 coupled to the barrel 130, the user can remove the cap 170 from the needle hub 160 if it is disposed thereabout. In other instances, the cap 170 can already be removed. As such, the user can position the injector 100 relative to the ocular tissue such that the microneedle 166 disposed at or near a desired injection site. In some instances, the injection site can be a predetermined distance from, for example, the limbus 32. For example, as shown in FIG. 17, the injection site can be a distance D₂ from the limbus 32 that is about 1 mm, about 2 mm, about 3 mm, about 4 mm, about 5 mm, about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, or more. In other instances, an injection site can be relative to any suitable portion of the eye.

[0099] With the microneedle 166 at or near the desired injection site, the base 165 of the needle hub 160 can be pressed against a target surface of the eye 10 as the microneedle 166 is inserted into the target surface. As such, the base 165 of the needle hub 160 can deform, define an indent, and/or otherwise form a "dimple" in the target surface (e.g., the conjunctiva 45 of the eye 10, as shown in FIG. 18). The "dimple" can facilitate a desired transfer of the medicament from the barrel 130 to the target region via the microneedle 166. The base 165 of the needle hub 160, and thus the dimple, can be maintained in such a position throughout the procedure (e.g., the injection of medicament into a SCS 36). In this manner, the "dimple" (e.g., the interface between the distal surface of the base 165 and the surface of the target location) can limit and/or prevent seepage of the medicament from the target region during injection and post-injection, thereby promoting desirable transfer of the medicament to the target region (e.g., the SCS 36). As described above, in some embodiments, the distal (or contact) surface of the base 165 can include a sealing portion, which can be a convex surface, a surface having a smooth finish (e.g., with a surface finish of less than Ra = 1.6 μm) or the like.

[00100] In addition, in some embodiments, the microneedle 166 is inserted substantially perpendicular or at an angle from about 80° to about 100°, into the eye 10, reaching the suprachoroidal space in a short penetration distance (e.g., about 1.1 mm, about 1 mm, about 0.9 mm, or less). This is in contrast to long conventional microneedles 166 or a cannula, which approach the suprachoroidal space at a steep angle, taking a longer penetration path through the sclera 20 and other ocular tissues, increasing the invasiveness of the method, the size of the microneedle track and consequently increasing the risk of infection and/or vascular rupture. With such long microneedles 166, the ability to precisely control insertion depth is diminished relative to the micromicroneedle 166 approach described herein.

[00101] Once the distal end portion of the microneedle 166 is disposed within at least one of the SCS 36, a lower portion of the sclera 20, and/or an upper portion of the choroid 28 of the eye 10 (FIG. 18), the medicament can be conveyed from the barrel 130. More specifically, while maintaining the dimple at the conjunctiva 45, a user can exert a force on the handle 1 10 to begin an infusion event. In some intsances, such as during insertion, the force exerted by a user on the handle 1 10 can be insufficient to move the piston 150 within the barrel 130 when the distal tip of the microneedle 166 is not disposed within the desired position (e.g., when the microneedle 166 is in the sclera 20 and not the SCS 36 of the eye 10). Said another way, the injector 100 can be configured to assist a user in delivering at least a portion of the drug formulation to the region, while be configured or "calibrated" to limit and/or prevent delivery to another, different region.

[00102] In some embodiments, the injector 100 can be configured to inform the user when the distal tip of the microneedle 166 is in the target region, for example, such that the drug formulation can be delivered to the target region with high confidence. For example, the injector 100 can be configured to limit movement of the piston 150 within the lumen 133 of the barrel 130 when the distal tip of the microneedle 166 is disposed within a region of the eye 10, which has a greater density, such as the sclera 20. In some instances, the injector 100 can limit movement of the piston 150 within the lumen 133 when the applied force is below a predetermined threshold such as about 6 Newtons (N). Conversly, the injector 100 can allow movement of the piston 150 within the barrel 130 when the distal tip of the microneedle 166 is disposed within the target location (e.g., a region having a lower density, such as the SCS 36) and when the force having the magnitude of less than about 6 N is exerted on the piston 150 and/or the handle 1 10. In this manner, the system can be configured or "calibrated" to provide feedback (e.g., tactile feedback) to a user to allow the user to deliver the drug formulation to a target region with high confidence. In some instances, the user can observe movement, or lack of movement, of the piston 150 within the barrel 130 to determine whether medicament has been conveyed to the eye. If the medicament has not been conveyed, the user can respond accordingly. For example, the user can re-align the system, relocate to a different injection site, and/or use a different sized microneedle 166 (e.g., a different microneedle 166 length).

[00103] By way of example, a user can manipulate the injector 100 to insert the microneedle 166 into the eye 10 at a desired injection site. In some instances, if the distal tip of the microneedle 166 is not disposed in the desired position and is, instead, disposed in the sclera 20, a force exerted by the user on the handle 1 10 can be insufficient to move the piston 150 within the barrel 130. For example, the sclera 20 can produce a backpressure that, in conjunction with the friction between the elastomeric member 155 and the inner surface of the barrel 130 and resistance to flow caused by the characteristcs of the drug (e.g., viscosity, density or the like), overcomes the force exerted by the user, thereby preventing and/or limiting delivery of the drug formulation to the sclera 20. In other words, the injector 100 is specifically configured or "calibrated" such that the force is insufficient to convey the drug formulation to the sclera 20. Conversely, when the distal tip of the microneedle 166 is disposed in, for example, the SCS 36 of the eye 10, the same force exerted by the user can be sufficient to move the piston 150 within the barrel, based at least in part on anatomical differences and/or the differences in material properties between the sclera 20 and the SCS 36 (e.g., densities or the like). In other words, the force can be sufficient to overcome a backpressure produced by the SCS 36. In this manner, the injector 100 can be configured to ensure that the injection is initiated only when the distal tip of the microneedle 166 is in and/or near the SCS 36 such that the drug formulation (e.g., a medicament such as, for example, a corticosteroid (e.g., triamcinolone) VEGF inhibitor, a combination thereof, or any other medicament described herein) can be delivered only to that region. Moreover, the SCS 36 produces a first pressure that resists and/or opposes flow from the distal tip of the microneedle 166, and the sclera 20 produces a second pressure that resists and/or opposes flow from the distal tip of the microneedle 166, which is higher than the first pressure. In this manner, a user can be informed by a loss of resistance felt at the handle 1 10 when the distal tip of the microneedle 166 is transitioned from the sclera 20 to or near the SCS 36.

[00104] In some embodiments, the force exerted can be about 2 N, about 3 N, about 4 N, about 5 N, about 6 N or more and inclusive of all ranges therebetween. In some embodiments, the piston 150 and the barrel 130 can be collectively configured such that the force produces an injection pressure within the barrel 130 of between about 100 kPa and about 500 kPa. For example, in some embodiments, the injection pressure can be about 100 kPa, 1 10 kPa, 120 kPa, 130 kPa, 140 kPa, 150 kPa, 160 kPa, 170 kPa, 180 kPa, 190 kPa, 200 kPa, 220 kPa, 240 kPa, 260 kPa, 280 kPa, 300 kPa, 320 kPa, 340 kPa, 360 kPa, 380 kPa, 400 kPa, 420 kPa, 440 kPa, 460 kPa, or about 480 kPa, inclusive of all ranges and values therebetween. The injection pressure can be sufficient to overcome the backpressure produced by SCS 36, but insufficient to overcome the backpressure produced by the sclera 20. In some embodiments, the force can be varied depending on the diameter of the barrel 130 and/or the piston 150, the viscosity of the drug formulation, and/or the material of the barrel 130 and/or the piston 150. In this manner, regardless of the variations in the piston 150, the barrel 130, and/or the drug formulation, the injector 100 produces an injection pressure within the barrel 130 of between about 100 kPa and about 500 kPa.

[00105] In some embodiments, the injector 100 can be configured such that injection distance traversed by the piston 150 is sufficient to deliver substantially the entire desired dose of the drug formulation into the SCS 36. In other embodiments, the injector 100 can be configured such that the injection distance traversed by the piston 150 is sufficient to deliver only a portion of the desired dose of the drug formulation into the SCS 36. In such embodiments, the injector 100 can be configured to initiate delivery of the drug formulation into the SCS 36, for example, to inform the user that the distal tip of the microneedle 166 is disposed within the SCS 36 (e.g., the user would see or otherwise detect that the piston 150 has moved, thus indicating the desired positioning of the microneedle 166). Said another way, the injector 100 can assist the user in determining whether the distal tip of the microneedle 166 is within the SCS 36 or not by initiating delivery of the drug formulation. In such embodiments, the injection distance can be a first injection distance. The user can then move the distal end portion of the piston 150 a second injection distance, for example, by applying a manual force on the piston 150 (e.g., by moving the handle 1 10 relative to the barrel 130, as described herein).

[00106] After desirable conveyance of the medicament from the medicament container, the hub 160 can be maintained in contact with the target surface for a time to allow for a desired medicament absorption by the eye. In this manner, the medicament can spread through tissues of the back of the eye without the medicament seeping from the injection site (e.g., where the microneedle 166 pierced the conjunctiva). As described above, in some embodiments, the distal end surface of the base 165 can include a sealing portion configured to form a substantially fluid- tight seal with the conjunctiva to limit movement of the medicament out of the eye along the needle track. In this manner, the injector 100 and the methods described herein can facilitate delivery of the desired dose to the desired regions of the eye.

[00107] Although the microneedle 166 is described above as having an effective length that is about 900 μm, in other embodiments, the injector 100 can be coupled to a needle hub that includes a microneedle with any suitable effective length. For example, FIGS. 19 and 20 illustrate a needle hub 260 according to another embodiment. The needle hub 260 has a proximal end portion 261, a distal end portion 262, and an indicator portion 268. In some embodiments, the needle hub 260 can be substantially similar in form and function as the needle hub 160 described in detail above with reference to FIGS. 11-13. Thus, portions of the needle hub 260 are not described in further detail herein. The needle hub 260 can differ, however, by being coupled to a base 265 including a microneedle 266 with an effective length greater than the effective length of the microneedle 160. For example, in this embodiment, the microneedle 266 extends from the base 265 by a distance D₃ of about 1100 μm. Moreover, the indicator portion 268 of the needle hub 260 is configured to present a visual indication associated with the effective length and/or distance D₃ (e.g., represented in FIGS. 19 and 20 with the text " 1100").

[00108] In yet other embodiments, an injector can include a microneedle having an effective length of between about 200 μm and about 1500 μm. A short effective length microneedle (e.g., a length of between about 200 μm and about 400 μm) can be used, for example, in various subdermal injection procedures. Injectors with a longer effective length microneedle (e.g., a length of between about 1200 μm and about 1500 μm) can be used, for example, in various ocular procedures, such as, injection into the subretinal space.

[00109] Referring now to FIG. 21, a flowchart is shown illustrating a method 1000 of using a medical injector to deliver a drug formulation to ocular tissue according to an embodiment. The method 1000 includes placing a needle hub of an injector in contact with a surface of an eye at a target location, at 1001. The medical injector (also referred to herein as "injector") can be any suitable injector. For example, in some embodiments, the injector can be substantially similar to or the same as the injector 100 described above. As such, the injector can include at least a handle, a barrel, a piston, and the needle hub. As described above, the piston can be at least partially disposed in the handle and fixedly coupled thereto. A portion of the barrel can be movably disposed in the handle to allow for relative movement, for example, in a proximal or distal direction direction. The barrel can define a lumen configured to movably receive a portion of the piston and that can receive, store, and/or contain a volume of a drug formulation. The needle hub can be coupled to the barrel to place a lumen of a microneedle coupled thereto, in fluid communication with the lumen of the microneedle. [00110] A first force is exerted on a portion of the injector to deform a portion of the surface of the eye associated with the target location, at 1002. For example, in some instances, a user can align the injector with a target location along the surface of the eye and can move the injector to insert the microneedle into the eye and to place the needle hub in contact with a surface of the eye. The user can then exert the first force on the handle, and in response, at least a portion of the first force is transferred from the needle hub to the surface of the eye. For example, in some instances, the needle hub can exert on the conjunctiva, which can result in a dimple being formed in the conjunctiva. In some instances, the needle hub can remain in contact with the eye and can continue to deform the portion of the eye until after an injection event, which in turn, can prevent seepage and/or the like.

[00111] A second force is exerted on the portion of the injector to move a needle (e.g., the microneedle) of the injector through the sclera of the eye until a distal surface of the needle is disposed at a predetermined depth within the eye, at 1003. In some embodiments, the arrangement of the injector can be such that prior to the distal surface of the needle being disposed at the predetermined depth, the second force exerted on the portion of the injector is sufficient to move the needle through the ocular tissue, but insufficient to move the piston within the barrel. For example, in some embodiments, the piston can include an elastomeric member (e.g., a plunger or the like) that can form a friction fit with an inner surface of the barrel, which in turn, can define a reaction force that resists the movement of the piston within the barrel. Moreover, in some instances, the ocular tissue exerts a backpressure or the like in response to the insertion of the needle. As such, the amount of force exerted to move the needle through the ocular tissue (e.g., the sclera) can be less than an amount of force to move the piston within the barrel and/or otherwise inject the drug formulation.

[00112] A volume of a drug formulation is expelled through the needle and into a region of the eye associated with a suprachoroidal space, at 1004. In some instances, the region of the eye can be disposed at the predetermined depth within the eye. More specifically, while the injector is described above as moving the needle through the eye substantially without expelling the drug formulation in response to the second force, the second force exerted on the portion of the injector (e.g., the handle) can be sufficient to expel the drug formulation through the needle and into the suprachoroidal space when the needle is disposed at a predetermined depth. For example, in some instances, the density of the sclera and the friction force between the piston and the inner surface of the barrel, collectively, are sufficient to resist a distal movement of the piston in response to the second force. Conversely, once the distal surface of the needle is disposed at a depth within the eye (e.g., at or near the suprachoroidal space), the density of that portion of the eye can be less than the density of the sclera. Thus, the collective force exerted by the friction force and the anatomy of the eye in response to the second force is reduced. In this manner, the second force can become sufficient to move the piston in the distal direction within the barrel to expel the drug formulation into the suprachoroidal space. In some instances, the user exerting the second force on the portion of the injector can feel a loss of resistance and/or the like, which can be an indication that the distal surface of the needle is disposed at a desired depth.

[00113] While the method 1000 is described above as including a set of steps, in some instances, the method 1000 can include any number of optional steps and/or pre-procedural or post-procedural steps. For example, in some embodiment, a method of delivering a drug formulation to ocular tissue in a clinical study can be similar to the method 1000 and can include at least some of the following steps:

1. Ensure a study participant' s eye remains dilated.

2. Anesthetize study eye (e.g., with topical anesthesia).

3. Wait appropriate amount of time after the placement of anesthesia.

4. Sterilize and prep eye, insert lid speculum and ensure eyelids are fully retracted per standard of care, and measure injection site with calipers.

5. Retrieve the study drug kit.

6. Remove vial of a drug formulation and shake vigorously for 10 seconds before use to ensure a uniform suspension.

7. Remove plastic top from vial and prepare vial using standard aseptic techniques.

8. Prepare an injector. The injector can be any of the injectors shown and described herein, such as the injector 100. a. Attach the provided drug transfer needle (sterile, disposable, hypodermic needle) to the microinjector.

b. Insert the drug transfer needle into the vial by piercing the septum.

c. Invert the vial, inject the air and withdraw > 200 uL the drug formulation by pulling back on the microinjector handle.

d. Withdraw drug transfer needle from the vial.

e. Remove the drug transfer needle from the microinjector handle and attach the microneedle (900 μm). The microneedle can include the hub 160 shown and described above.

f. Prime the injector and ensure enough drug is available to deliver 100 μL, of the drug formulation into the SCS.

9. After priming, the drug formulation should be injected without delay to prevent settling of the drug in the syringe.

10. Holding the microinjector, insert the microneedle into the sclera perpendicular to the ocular surface. Target location should be approximately 4-5 mm from the limbus and the superior temporal quadrant is the recommended location for suprachoroidal injections. Ensure the approach is as perpendicular to the sclera as possible. Do not bend or angle the microneedle at any time during the procedure.

11. Once the microneedle is inserted into the sclera, ensure that the hub of the microneedle is in firm contact with the conjunctiva. Firm contact of the microneedle injection system with the conjunctiva will be observed as a slight, localized dimple of the globe around the microneedle hub.

12. Stabilize the microneedle with one hand while applying this constant downward force throughout the injection procedure.

13. Using the other hand (if necessary), advance the injector handle until up to 100 μL, of the drug formulation is injected over a 5-10 second period. During this process, ensure that nominal pressure continues to be placed on the needle such that it is in tight contact with the conjunctiva.

14. If there is resistance to flow through the microneedle, remove the microneedle from the eye and examine the eye for any issues. If subject safety is not at risk, investigator may choose to verify patency of the microneedle and use best medical judgment to restart the injection procedure at a new site adjacent to the original injection site or use a longer microneedle length (1 100 μm). Ensure there is enough the drug formulation remaining in the microinjector to prime the replacement microneedle and deliver a 100 μΐ dose. Repeat the microinjector process as stated above in step 9.

15. Maintain light pressure on the microneedle once injection is complete and hold for 5-10 seconds.

16. Obtain cotton swab and remove the microneedle slowly from the eye.

Simultaneously cover the injection site with the cotton swab.

17. Hold the swab over the injection site with light pressure for a few seconds to ensure minimal reflux upon removal. Remove cotton swab.

18. Remove the lid speculum.

19. Following the SCS injection, assess eye via indirect ophthalmoscope.

[00114] Alternatively, preparing an injector, which can be any of the injectors shown and described herein, suhb as the injector 100 (e.g., step 8 above) can include: a. Attach the provided vial access device (sterile, disposable) to the vial of study drug by inserting it into the vial while the vial is on a flat surface.

b. Detach the cap from the vial access device.

c. Fully pull back on the plunger handle to draw air into the injector.

d. Attach the microinjector handle (syringe) to the vial access device and inject the air.

e. Invert the vial and withdraw > 200 μL of the drug formulation by pulling back on the microinjector handle.

f. Replace the vial access device with the 900 μm needle.

g. Recap the vial access device.

h. Mark the injection site with the needle cap or calipers.

i. Prime the microinjector to remove the excess air. j . Depress the handle until the plunger reaches the 100 μL marking on the syringe.

[00115] Although the medical injectors and methods described herein are shown as including a device including a needle and a reservoir including a medicament, in other embodiments, a medical device or kit can include a simulated medicament injector. In some embodiments, the simulated medicament injector can correspond to an actual medicament injector (e.g., the medical injector 100 described above) and can be used, for example, to train a user in the operation of the corresponding actual medical injector, to perform a "sham" injection as part of a clinical trial protocol, or the like.

[00116] A simulated medical injector can simulate the actual medical injector in any number of ways. For example, in some embodiments, the simulated medical injector can have a shape corresponding to a shape of the actual medical injector (e.g., injector 100), a size corresponding to a size of the actual medical injector (e.g., injector 100) and/or a weight corresponding to a weight of the actual medical injector (e.g., injector 100). Moreover, in some embodiments, the simulated medical injector can include components that correspond to the components of the actual medical injector. In this manner, the simulated medical injector can simulate the look, feel and sounds of the actual medical injector. For example, in some embodiments, the simulated medical injector can include external components (e.g., a base, a handle, or the like) that correspond to external components of the actual medical injector. In some embodiments, the simulated medical injector can include internal components (e.g., a plunger) that correspond to internal components of the actual medical injector.

[00117] In some embodiments, however, the simulated medical injector can be devoid of a medicament and/or those components that cause the medicament to be delivered (e.g., a microneedle). In this manner, the simulated medical injector can be used to train a user in the use of the actual medical injector without exposing the user to a needle and/or a medicament. Moreover, the simulated medical injector can have features to identify it as a training device to prevent a user from mistakenly believing that the simulated medical injector can be used to deliver a medicament. [00118] In some embodiments, a method of delivering a drug formulation to ocular tissue in a clinical study can be similar to the method 1000 and can include at least some of the following steps:

1. Ensure a study participant's eye remains dilated.

2. Anesthetize study eye (e.g., with topical anesthesia).

3. Wait appropriate amount of time after the placement of anesthesia.

5. Retrieve the study drug kit.

6. Prepare microinjector. The microinjector can be any of the injectors shown and described herein, such as the injector 100. Moreover, the microinjector can be a simulated microinjector, including a needless hub. This preparation includes:

a. Attach the needleless hub to the microinjector handle

7. Prepare for sham (or training) procedure:

a. Holding the microinjector, press the sham needleless hub into the sclera at the target location.

b. Ensure the approach is as perpendicular to the sclera as possible. Do not angle the microinjector at any time during the procedure.

c. Ensure that the needleless hub is in firm contact with the conjunctiva. Firm contact of the microinjector with the conjunctiva will be observed as a slight, localized dimple of the globe around the needleless hub.

8. Administer sham procedure:

a. Maintain the needle hub against the eye while gently depressing the handle throughout the injection procedure. Perform a sham suprachoroidal injection to the study eye over a 5-10 second period.

b. Maintain the needleless hub against the eye for 5-10 seconds following the sham injection.

c. Obtain cotton swab and remove the needleless hub slowly from the eye.

Simultaneously cover the sham site with the cotton swab. d. Hold the swab over the injection site for a few seconds and then remove cotton swab.

9. Remove lid speculum.

10. Following the SCS injection, assess eye via indirect ophthalmoscope.

[00119] The microneedle devices described herein also may be adapted to use the one or more microneedles as a sensor to detect analytes, electrical activity, and optical or other signals. The sensor may include sensors of pressure, temperature, chemicals, and/or electromagnetic fields (e.g., light). Biosensors can be located on or within the microneedle, or inside a device in communication with the body tissue via the microneedle. The microneedle biosensor can be any of the four classes of principal transducers: potentiometric, amperometric, optical, and physiochemical. In one embodiment, a hollow microneedle is filled with a substance, such as a gel, that has a sensing functionality associated with it. In an application for sensing based on binding to a substrate or reaction mediated by an enzyme, the substrate or enzyme can be immobilized in the needle interior. In another embodiment, a wave guide can be incorporated into the microneedle device to direct light to a specific location, or for detection, for example, using means such as a pH dye for color evaluation. Similarly, heat, electricity, light, ultrasound or other energy forms may be precisely transmitted to directly stimulate, damage, or heal a specific tissue or for diagnostic purposes.

[00120] The microneedle device for non-surgically delivering drug to the suprachoroidal space of the eye of a human subject, in one embodiment, comprises a hollow microneedle. The device may include an elongated housing for holding the proximal end of the microneedle. The device may further include a means for conducting a drug formulation through the microneedle. For example, the means may be a flexible or rigid conduit in fluid connection with the base or proximal end of the microneedle. The means may also include a pump or other devices for creating a pressure gradient for inducing fluid flow through the device. The conduit may in operable connection with a source of the drug formulation. The source may be any suitable container. In one embodiment, the source may be in the form of a conventional syringe. The source may be a disposable unit dose container. [00121] The transport of drug formulation or biological fluid through a hollow microneedle can be controlled or monitored using, for example, one or more valves, pumps, sensors, actuators, and microprocessors. For instance, in one embodiment the microneedle device may include a micropump, microvalve, and positioner, with a microprocessor programmed to control a pump or valve to control the rate of delivery of a drug formulation through the microneedle and into the ocular tissue. The flow through a microneedle may be driven by diffusion, capillary action, a mechanical pump, electroosmosis, electrophoresis, convection or other driving forces. Devices and microneedle designs can be tailored using known pumps and other devices to utilize these drivers. In one embodiment, the microneedle device may further include an iontophoretic apparatus, similar to that described in U.S. Patent 6,319,240 to Beck, for enhancing the delivery of the drug formulation to the ocular tissue. In another embodiment the microneedle devices can further include a flowmeter or other means to monitor flow through the microneedles and to coordinate use of the pumps and valves.

[00122] In some embodiments, the flow of drug formulation or biological fluid can be regulated using various valves or gates known in the art. The valve may be one which can be selectively and repeatedly opened and closed, or it may be a single-use type, such as a fracturable barrier. Other valves or gates used in the microneedle devices can be activated thermally, electrochemically, mechanically, or magnetically to selectively initiate, modulate, or stop the flow of material through the microneedles. In one embodiment, the flow is controlled with a rate-limiting membrane acting as the valve.

[00123] In other embodiments, the flow of drug formulation or biological fluid can be regulated by the internal friction of various components, the characteristics of the medicament to be injected (e.g., the viscosity) and/or the characteristics of the desired injection site. For example, as described above, in some embodiments, a drug product can be configured for delivery of a specific formulation to a specific location. In such embodiments, a drug product can include a microinjector (e.g., microinjector 100) and a medicament (e.g., triamcinolone or any other formulations described herein) that is configured to deliver the medicament to a specific target region (e.g., the SCS). In this example, the drug product can be configured such that the flow of the medicament is limited when injection is attempted into a different target region having a higher density (e.g., the sclera). Thus, the drug product is configured to regulate the flow by allowing flow when the injection is attempted into the desired target region.

[00124] The microneedle, in one embodiment, is part of an array of two or more microneedles such that the method further includes inserting at least a second microneedle into the sclera without penetrating across the sclera. In one embodiment, where an array of two or more microneedles are inserted into the ocular tissue, the drug formulation of each of the two or more microneedles may be identical to or different from one another, in drug, formulation, volume/quantity of drug formulation, or a combination of these parameters. In one case, different types of drug formulations may be injected via the one or more microneedles. For example, inserting a second hollow microneedle comprising a second drug formulation into the ocular tissue will result in delivery of the second drug formulation into the ocular tissue.

[00125] In another embodiment, the device includes an array of two or more microneedles. For example, the device may include an array of from 2 to 1000 (e.g., from 2 to 100 or from 2 to 10) microneedles. In one embodiment, a device includes between 1 and 10 microneedles. An array of microneedles may include a mixture of different microneedles. For instance, an array may include microneedles having various lengths, base portion diameters, tip portion shapes, spacings between microneedles, drug coatings, etc. In embodiments wherein the microneedle device comprises an array of two or more microneedles, the angle at which a single microneedle extends from the base may be independent from the angle at which another microneedle in the array extends from the base.

[00126] The SCS drug delivery methods provided herein allow for the delivery of drug formulation over a larger tissue area and to more difficult to target tissue in a single administration as compared to previously known needle devices. Not wishing to be bound by theory, it is believed that upon entering the SCS the drug formulation flows circumferentially from the insertion site toward the retinochoroidal tissue, macula, and optic nerve in the posterior segment of the eye as well as anteriorly toward the uvea and ciliary body. In addition, a portion of the infused drug formulation may remain in the SCS as a depot, or remain in tissue overlying the SCS, for example the sclera, near the microneedle insertion site, serving as additional depot of the drug formulation that subsequently can diffuse into the SCS and into other adjacent posterior tissues.

[00127] The human subject treated with the methods and devices provided herein may be an adult or a child. In one embodiment, the patient presents with a retinal thickness of greater than 300 μm (e.g., central subfield thickness as measured by optical coherence tomography). In another embodiment, the patient in need of treatment has a BCVA score of≥ 20 letters read in each eye (e.g., 20/400 Snellen approximate). In yet another embodiment, the patient in need of treatment has a BCVA score of≥ 20 letters read in each eye (e.g., 20/400 Snellen approximate) , but < 70 letters read in the eye in need of treatment.

[00128] Therapeutic response, in one embodiment, is assessed via a visual acuity measurement at one and/or two months post treatment (e.g., by measuring the mean change in best corrected visual acuity (BCVA) from baseline, i.e., prior to treatment). In one embodiment, a patient treated by one or more of the methods provided herein experiences an improvement in BCVA from baseline, at any given time point (e.g., 2 weeks after administration, 4 weeks after administration, 2 months after at least one dosing session, 3 months after administration), of at least 2 letters, at least 3 letters, at least 5 letters, at least 8 letters, at least 12 letters, at least 13 letters, at least 15 letters, at least 20 letters, and all values in between, as compared to the patient's BVCA prior to the at least one dosing session.

[00129] In one embodiment, the patient gains about 5 letters or more, about 10 letters or more, 15 letters or more, about 20 letters or more, about 25 letters or more in a BCVA measurement after a dosing regimen is complete, for example a monthly dosing regimen, compared to the patient's BCVA measurement prior to undergoing treatment. In even a further embodiment, the patient gains from about 5 to about 30 letters, 10 to about 30 letters, from about 15 letters to about 25 letters or from about 15 letters to about 20 letters in a BCVA measurement upon completion of at least one dosing session, compared to the patient's BCVA measurement prior to the at least one dosing session. In one embodiment, the BCVA gain is about 2 weeks, about 1 month, about 2 months, about 3 months or about 6 months after the at least one dosing session. In another embodiment, the BCVA is measured at least about 2 weeks, at least about 1 month, at least about 2 months, at least about 3 months or at least about 6 months after the at least one dosing session.

[00130] In one embodiment, the BCVA is based on the Early Treatment of Diabetic

Retinopathy Study (ETDRS) visual acuity charts and is assessed at a starting distance of 4 meters.

[00131] In another embodiment, the patient subjected to a treatment method, e.g., with one of the devices provided herein substantially maintains his or her vision subsequent to the treatment (e.g., a single dosing session or multiple dosing sessions), as measured by losing fewer than 15 letters in a best-corrected visual acuity (BCVA) measurement, compared to the patient's BCVA measurement prior to undergoing treatment. In a further embodiment, the patient loses fewer than 10 letters, fewer than 8 letters, fewer than 6 letters or fewer than 5 letters in a BCVA measurement, compared to the patient's BCVA measurement prior to undergoing treatment.

[00132] A decrease in retina thickness and/or macula thickness is one measurement of treatment efficacy of the methods provided herein. For example, in one embodiment, a macular edema an exudative macular degeneration (wet AMD) patient treated by one of the methods provided herein for example with one of the devices described herein experiences a decrease in retinal thickness from baseline (e.g., retinal thickness such as central subfield thickness (CST) prior to treatment), at any given time point after at least one dosing session (single session or multiple dosing sessions, of at least about 20 μm, or at least about 40 μm, or at least about 50 μm, or at least about 100 μm, or at least about 150 μm or at least about 200 μm, or from about 50-100 μm, and all values in between. In another embodiment, the patient experiences a≥ 5%,≥ 10%,≥ 15%,≥ 20%,≥ 25% decrease in retinal thickness (e.g., CST) subsequent to at least one dosing session.

[00133] In one embodiment, a patient treated by the methods provided herein experiences a decrease in retinal thickness from baseline (i.e., retinal thickness prior to treatment), at any given time point, of from about 20 μm to about 200 μm, at from about 40 μm to about 200 μm, of from about 50 μm to about 200 μm, of from about 100 μm to about 200 μm, or from about about 150 μm to about 200 μm. In one embodiment, change in retinal thickness from baseline is measured as a change in CST, for example, by spectral domain optical coherence tomography (SD-OCT). In one embodiment, the change in retinal thickness.

[00134] In one embodiment, the decrease in retinal thickness is measured about 2 weeks, about 1 month, about 2 months, about 3 months or about 6 months after the at least one dosing session. In another embodiment, the decrease in retinal thickness is measured at least about 2 weeks, at least about 1 month, at least about 2 months, at least about 3 months or at least about 6 months after the at least one dosing session. In one embodiment, where multiple dosing sessions are employed, a decrease in retinal thickness is sustained by the patient for at least about 2 weeks, at least about 1 month, at least about 2 months, at least about 3 months or at least about 6 months after each dosing session.

[00135] As used herein, "non-surgical" ocular drug delivery methods refer to methods of drug delivery that do not require general anesthesia and/or retrobulbar anesthesia (also referred to as a retrobulbar block). Alternatively or additionally, a "non-surgical" ocular drug delivery method is performed with an instrument having a diameter of 28 gauge or smaller. Alternatively or additionally, "non-surgical" ocular drug delivery methods do not require a guidance mechanism that is typically required for ocular drug delivery via a shunt or cannula.

[00136] In one embodiment, the suprachoroidal drug dose sufficient to achieve a therapeutic response in a human subject treated with the non-surgical SCS drug delivery method is less than the intravitreal, parenteral, intracameral, topical, or oral drug dose sufficient to elicit the identical or substantially identical therapeutic response. In a further embodiment, the suprachoroidal drug dose is at least 10 percent less than the oral, parenteral or intravitreal dose sufficient to achieve the identical or substantially identical therapeutic response. In a further embodiment, the suprachoroidal dose is about 10 percent to about 25 percent less, or about 10 percent to about 50 percent less than the oral, parenteral, intracameral, topical, or intravitreal dose sufficient to achieve the identical or substantially identical therapeutic response.

[00137] As provided throughout, the compositions administered herein in one embodiment, the methods described herein comprise administering a tyrosine kinase inhibitor. [00138] Exemplary tyrosine kinase inhibitors for use in the methods described herein include, but are not limited to, Alectinib (Alecensa®); angiokinase inhibitors such as Nintedanib (Vargatev®), Afatinib (Gilotrif®), and Motesanib; Apatinib; Axitinib; Cabozantinib (Cometriq®); Canertinib; Crenolanib; Damnacanthal; Foretinib; Fostamatinib; growth factor receptor inhibitor; Ibrutinib (Imbruvica®); Icotinib; Imatinib (Gleevec®); Linifanib; Mubritinib; Radotinib; T790M; V600E; Vatalanib; Vemurafenib (Zelboraf®); AEE788 (TKI, VEGFR-2, EGFR: Novartis); ZD6474 (TKI, VEGFR- 1, -2, -3, EGFR: Zactima: AstraZeneca); AZD2171 (TKI, VEGFR- 1, -2: AstraZeneca); SU 11248 (TKI, VEGFR- 1, -2, PDGFR: Sunitinib: Pfizer); AG13925 (TKI, VEGFR- 1, -2: Pfizer); AGO 13736 (TKI, VEGFR- 1, -2: Pfizer); CEP-7055 (TKI, VEGFR- 1, -2, -3 : Cephalon); CP-547,632 (TKI, VEGFR- 1, -2: Pfizer); GW7S6024 (TKL VEGFR- 1, -2, -3 : GlaxoSmithKline); GW786034 (TKI, VEGFR- 1, -2, -3 : GlaxoSmithKline); sorafenib (TKI, Bay 43-9006, VEGFR- 1, -2, PDGFR: Bayer/Onyx); SU4312 (TKI, VEGFR-2, PDGFR: Pfizer); AMG706 (TKI, VEGFR- 1, -2, -3 : Amgen); XL647 (TKI, EGFR, HER2, VEGFR, ErbB4: Exelixis); XL999 (TKI, FGFR, VEGFR, PDGFR, FII-3: Exelixis); PKC412 (TKI, KIT, PDGFR, PKC, FLT3, VEGFR-2: Novartis); AEE788 (TKI, EGFR, VEGFR2, VEGFR- 1 : Novartis): OSI-030 (TKI, c-kil, VEGFR: OSI Pharmaceuticals); OS1-817 (TKI c-kit, VEGFR: OSI Pharmaceuticals); DMPQ (TKI, ERGF, PDGFR, ErbB2. p56. pkA, pkC); MLN518 (TKI, Flt3, PDGFR, c-KIT (T53518: Millennium Pharmaceuticals); lestaurinib (TKI, FLT3, CEP-701, Cephalon); ZD 1839 (TKI, EGFR: gefitinib, Iressa: AstraZeneca); OSI-774 (TKI, EGFR: Erlotininb: Tarceva: OSI Pharmaceuticals); lapatinib (TKI, ErbB-2, EGFR, and GD-2016: Tykerb: GlaxoSmithKline).

[00139] In one embodiment, the tyrosine kinase inhibitor may be used in combination with one or more agents listed herein or with other agents known in the art, either in a single or multiple formulations.

[00140] In one embodiment, the agent is a VEGF modulator and is administered intravitreally to the patient in need of treatment.

[00141] In one embodiment, the VEGF modulator is a VEGF antagonist.

[00142] In one embodiment, the second drug is a VEGF antagonist including, without limitation, a VEGF-receptor kinase antagonist, an anti-VEGF antibody or fragment thereof, an anti-VEGF receptor antibody, an anti-VEGF aptamer, a small molecule VEGF antagonist, a thiazolidinedione, a quinoline or a designed ankyrin repeat protein (DARPin).

[00143] In one embodiment, the VEGF antagonist includes, but is not limited to, aflibercept, ziv-aflibercept, bevacizumab, sonepcizumab, VEGF sticky trap, cabozantinib, foretinib, vandetanib, nintedanib, regorafenib, cediranib, ranibizumab, lapatinib, sunitinib, sorafenib, plitidepsin, regorafenib, verteporfin, bucillamine, axitinib, pazopanib, fluocinolone acetonide, nintedanib, AL8326, 2C3 antibody, AT001 antibody, XtendVEGF antibody, HuMax- VEGF antibody, R3 antibody, AT001/r84 antibody, HyBEV, ANG3070, APX003 antibody, APX004 antibody, ponatinib, BDM-E, VGX100 antibody, VGX200, VGX300, COSMIX, DLX903/1008 antibody, ENMD2076, INDUS815C, R84 antibody, KD019, NM3, MGCD265, MG516, MP0260, NT503, anti -DLL4/ VEGF bispecific antibody, PAN90806, Palomid 529, BD0801 antibody, XV615, lucitanib, motesanib diphosphate, AAV2-sFLT01, soluble Fltl receptor, AV-951, Volasertib, CEP11981, KH903, lenvatinib, lenvatinib mesylate, terameprocol, PF00337210, PRS050, SP01, carboxyamidotriazole orotate, hydroxychloroquine, linifanib, ALGIOOI, AGN150998, MP0112, AMG386, ponatinib, PD173074, AVA101, BMS690514, KH902, golvatinib (E7050), dovitinib, dovitinib lactate (TKI258, CHIR258), ORA101, ORA102, Axitinib (Inlyta, AGO 13736), PTC299, pegaptanib sodium, troponin, EG3306, vatalanib, BmablOO, GSK2136773, Anti-VEGFR Alterase, Avila, CEP7055, CLT009, ESBA903, GW654652, HMPL010, GEM220, HYB676, JNJ17029259, TAK593, Nova21012, Nova21013, CP564959, smart Anti-VEGF antibody, AG028262, AG13958, CVX241, SU14813, PRS055, PG501, PG545, PTIlOl, TG100948, ICS283, XL647, enzastaunn hydrochloride, BC194, COT601M06.1, COT604M06.2, MabionVEGF, Apatinib, RAF265 (CHIR-265), Motesanib Diphosphate (AMG-706), Lenvatinib (E7080), TSU-68 (SU6668, Orantinib), Brivanib (BMS-540215), MGCD-265, AEE788 (NVP-AEE788), ENMD-2076, OSI-930, CYC116, ΚΪ8751, Telatinib, KRN 633, SAR131675, Dovitinib (TKI-258) Dilactic Acid, Apatinib, BMS-794833, Brivanib Alaninate (BMS-582664), Golvatinib (E7050), Semaxanib (SU5416), ZM 323881 HC1, Cabozantinib malate (XL184), ZM 306416, AL3818, AL8326, 2C3 antibody, AT001 antibody, HyBEV, bevacizumab (Avastin®), ANG3070, APX003 antibody, APX004 antibody, ponatinib (AP24534), BDM-E, VGX100 antibody (VGX100 CIRCADIAN), VGX200 (c-fos induced growth factor monoclonal antibody), VGX300, COSMIX, DLX903/1008 antibody, E MD2076, sunitinib malate (Sutent®), INDUS815C, R84 antibody, KD019, M3, allogenic mesenchymal precursor cells combined with an anti-VEGF antagonist (e.g., anti-VEGF antibody), MGCD265, MG516, VEGF-Receptor kinase inhibitor, MP0260, NT503, anti -DLL4/VEGF bispecific antibody, PAN90806, Palomid 529, BD0801 antibody, XV615, lucitanib (AL3810, E3810), AMG706 (motesanib diphosphate), AAV2-sFLT01, soluble Fltl receptor, cediranib (Recentin™), AV-951, tivozanib (KRN-951), regorafenib (Stivarga®), volasertib (BI6727), CEP11981, KH903, lenvatinib (E7080), lenvatinib mesylate, terameprocol (EM 1421), ranibizumab (Lucentis®), pazopanib hydrochloride (Votrient™), PF00337210, PRS050, SP01 (curcumin), carboxyamidotriazole orotate, hydroxychloroquine, linifanib (ABT869, RG3635), fluocinolone acetonide (Iluvien®), ALGIOOI, AGN150998, DARPin MP0112, AMG386, ponatinib (AP24534), AVA101, nintedanib (Vargatef™), BMS690514, KH902, golvatinib (E7050), everolimus (Afinitor®), dovitinib lactate (TKI258, CHIR258), ORA101, ORA102, axitinib (Inlyta®, AGO 13736), plitidepsin (Aplidin®), PTC299, aflibercept (Zaltrap®, Eylea®), pegaptanib sodium (Macugen™, LI900015), verteporfin (Visudyne®), bucillamine (Rimatil, Lamin, Brimani, Lamit, Boomiq), R3 antibody, AT001/r84 antibody, troponin (BLS0597), EG3306, vatalanib (PTK787), BmablOO, GSK2136773, Anti-VEGFR Alterase, Avila, CEP7055, CLT009, ESBA903, HuMax-VEGF antibody, GW654652, HMPL010, GEM220, HYB676, JNJ17029259, TAK593, XtendVEGF antibody, Nova21012, Nova21013, CP564959, Smart Anti-VEGF antibody, AG028262, AG13958, CVX241, SU14813, PRS055, PG501, PG545, PTI101, TG100948, ICS283, XL647, enzastaurin hydrochloride (LY317615), BC194, quinolines, COT601M06.1, COT604M06.2, MabionVEGF, SIR-Spheres coupled to anti-VEGF or VEGF-R antibody, Apatinib (YN968D1), or AL3818.

EXAMPLES

[00144] The present invention is further illustrated by reference to the following

Examples. However, it should be noted that these Examples, like the embodiments described above, are illustrative and are not to be construed as restricting the scope of the invention in any way.

Example 1. Axitinib Formulation [00145] One exemplary Axitinib formulation, denoted CLS011A has the following components.

The formulation is terminally sterilized via autoclave; no preservative is present.

Example 2. Collection of Samples for Determination of the Ocular Distribution of Test Article Following Suprachoroidal Administration to Pigmented Rabbits

[00146] The purpose of this study was to assess the pharmacokinetics and ocular tissue distribution following a single bilateral suprachoroidal microneedle injection of CLS011A at 4 mg/eye (100

to male pigmented Dutch Belted rabbits. The animals eyes were examined by a board certified veterinary ophthalmologist using a slitlamp biomicroscope and an indirect ophthalmoscope. The exams occured predose and on Study Days 4, 15, 28, and 91 prior to sacrifice, as applicable. On specified days through Study Day 91, two animals/time points were euthanized for the collection of blood (for plasma) and ocular tissues (aqueous humor, vitreous humor, retina, and sclera/choroid-RPE). Plasma and ocular tissues were analyzed for concentrations of CLSOl 1 A using liquid chromatography/mass spectrometry.

[00147] Following a single bilateral administration to the suprachoroidal space through a microneedle in male rabbits, CLSOl 1 A was generally well tolerated through Study Day 91. In a few animals, clear subconjunctival fluid-filled channels were observed sporadically near the injection site on Study Day 15 and thereafter. Additionally, retinal pigmented epithelium (RPE) pigment mottling was observed in one eye on Day 91 of the dosing phase. No overt signs of toxicity were observed following the suprachoroidal administration of CLSOl 1 A.

[00148] Following many of the injections, small amount of test material may have been trapped under the conjunctiva or within the sclera upon needle withdrawal. The refluxed material may have appeared as subconjunctival white plaques to the examiner. In agreement with the postdose observations and exam findings, white deposits were observed during tissue collections. Up to 61 days postdose, white deposits were observed on the exterior of the eye and could be removed with the bulbar conjunctiva until Study Day 91, suggesting that the deposit was in part suprachoroidal in location.

[00149] Following a single bilateral suprachoroidal administration of CLSOl 1 A (4 mg/eye), the analyte was not observed at quantifiable levels in either plasma or aqueous humor samples. CLSOl 1 A was quantifiable at all time points in vitreous humor, retina, and sclera/choroid-RPE (SCR). A concentration gradient of CLSOl 1 A in tissues was present, with the dose depot (SCR) the highest, followed by the retina, and finally the vitreous humor with the lowest concentrations. The dose depot (SCR) extrapolated initial concentration (Co) was 17.2 mg/g. The mean concentrations of CLSOl 1 A in the SCR rose slightly on Study Day 4, most likely due to interanimal variability. The dose depot (SCR) concentrations of CLSOl 1 A were the highest early in the study, and then started to decline beyond Study Day 8 through Study Day 91. The high levels of CLSOl 1 A remaining coincided with observation of sub-scleral white plaques, suggesting that the plaques were remaining dose depot. The elimination half-life (ti_/2) was calculated to be 102 days, but this value should be interpreted with caution, as it was calculated over a period of less than two times the half-life. The observed exposure (AUC₀-_t) value of the dose depot was 1260 μg*day/g.

[00150] Although CLSOl 1 A is dosed as a suspension, with limited solubility in aqueous solvent, the immediate presence of CLSOl 1 A 24 hours postdose in retina and vitreous humor indicated a burst release of the test article into tissue following dosing. CLSOl 1 A levels in retina and vitreous humor increased over time, to a maximal mean concentration (C_max) of 325 μg/g and 0.857 μg/mL, respectively. The Cmax levels were reached in the vitreous humor on Study Day 4 (Tmax), and then declined thereafter albeit with some variability. The mean concentrations in retina were similar from Study Day 2 up to Study Day 15, and then increased approximately 3-fold on Study Day 29. The concentrations of CLSOl 1 A in retina were similar to the Cmax through Study Day 91. The observed exposure to CLSOl 1 A (AUCo-_t) in retina and vitreous humor was consistent with the concentration gradient between the two tissues. The retina concentrations of CLSOl 1 A remained above 44 μg/g throughout the duration of the study.

[00151] Experimental Design:

[00153] Male Dutch Belted [Haz:(DB)SPF] rabbits were used for the study. The animals were acclimated to study conditions for 16 days prior to dose administration. At dosing, the animals weighed 1721 to 1941 g and were 5 months of age. All animals were housed in individual, suspended, stainless steel cages during acclimation and the test period. Certified Hi- Fiber Rabbit Diet #5325 (PMI) was provided. Water was provided fresh daily, ad libitum. All animals were housed in individual, suspended, stainless steel cages during acclimation and the test period. Environmental controls for the animal room were set to maintain a temperature of 16 to 22°C (Deviation), a relative humidity of 50 ± 20% (Deviation), and a 12-hour light/12-hour dark cycle. As necessary, the 12-hour dark cycle was interrupted to accommodate study procedures. Each animal was assigned a temporary identification number. At selection, permanent animal numbers were assigned (Deviation). Each animal was uniquely identified with an individually numbered cage card prior to animal selection and an implantable microchip identification device upon assignment to the study. Immediately prior to dosing, animals were anesthetized with an intramuscular (IM) injection of ketamine, dexmedetomidine, and glycopyrrolate. Following application of topical anesthetic, eyes were rinsed with an iodine solution followed by a saline rinse. Animals were not fasted prior to dose administration.

[00154] The dosing formulation was drawn up into a 1-mL luer-lock syringe using a standard 21 -gauge, 1-inch needle; any bubbles were expressed, and the standard needle was replaced by a 30-gauge microneedle 700 μm in length. A single suprachoroidal injection of 100 μL was given over approximately 5-10 seconds to each eye (3-4 mm from the limbus, in the superior temporal quadrant) by an OSOD representative according to a study-specific procedure. Following the injection, the needle was kept in the eye for approximately 20 seconds before being withdrawn. Upon withdrawal of the microneedle, a cotton-tipped applicator (CTA, dose wipe) was placed over the injection site for approximately 10 seconds; the dose wipe was discarded. The eye was inspected to confirm accuracy of injection by an OSOD representative. The right eye was dosed first; all postdose times were based on the time of dosing of the second (left) eye. Any dosing observations were recorded.

[00155] Animals were given an intramuscular (IM) injection of flunixin (2 mg/kg) prior to sedation and approximately 24 hours (0.08 mL per animal) post the first flunixin administration, as applicable. Buprenorphine sustained release (SR, 0.2 mg/kg) was administered subcutaneously (SQ) and bland ophthalmic ointment was applied to each eye upon recovery. Animals were also given neo-poly-bac ointment and atropine ointment topical ocular to both eyes once following dosing on Study Day 1 and twice daily on Study Days 2 and 3.

[00156] Twice daily (a.m. and p.m.), animals were observed for mortality and signs of pain and distress. Cageside observations for general health and appearance, with particular attention paid to the eyes, were done once daily.

[00157] Body weights were taken on the day of arrival, at the time of animal selection, on the day of dose administration, and weekly throughout the remainder of the study, as applicable. [00158] A board-certified veterinary ophthalmologist conducted ophthalmic examinations predose and on Study Days 4, 15, 28, and 91. At each time point, using a slitlamp biomicroscope to examine the adnexa and anterior portion of each eye, an external examination was conducted. In addition, the eyes were dilated with a mydriatic agent, and the ocular fundus of each eye was examined using an indirect ophthalmoscope.

[00159] The following samples were collected for analysis.

[00160] Blood and Plasma: Two animals/time point were euthanized with an overdose of sodium pentobarbital and blood (approximately 5 mL) was collected via cardiac puncture into tubes containing K₂EDTA at 24, 72, and 168 hours postdose and on Study Days 15, 29, 61, and 91. Samples were maintained on wet ice until centrifuged to obtain plasma. All plasma samples were placed on dry ice prior to storage at approximately -70°C until analyzed. The cellular fraction was discarded. Additional blood was collected and discarded to facilitate collection of ocular tissues.

[00161] Ocular Tissues: At the time of sacrifice, both eyes were immediately enucleated.

The aqueous humor was collected and each eye was flash frozen in liquid nitrogen for 15 to 20 seconds, and subsequently placed on dry ice for at least 2 hours (Deviation). Within approximately one day, the following matrices were collected.

[00162] The ocular tissues were rinsed with saline and blotted dry, as appropriate, weighed, and placed on dry ice until stored at approximately -70 °C until analyzed. Residual carcasses and remaining ocular tissues were discarded [00163] Samples were uniquely identified to indicate origin and collection time. Test facility labels were used and samples were labeled with, at minimum, the animal number, dose group, collection time or interval, matrix, study number, and unique barcode.

[00164] Samples were stored as follows:

Note: Temperatures are approximate and are maintained and monitored in accordance with Covance SOPs.

[00165] Plasma and ocular tissues were analyzed for concentrations of CLS011A using liquid chromatography/mass spectrometry.

[00166] Values from instruments such as balances are reported as generated by (or recorded from) each instrument. Unless otherwise noted, calculated values for mean and standard deviation are reported to three significant figures. Statistical analyses were limited to descriptive statistics such as mean and standard deviation. Because the data were computer- generated and rounded appropriately for inclusion in the report, the use of reported values to calculate subsequent parameters will, in some instances, yield minor variations from those listed in the tables. Dose tables were compiled with values calculated using Excel, Version 14.0 (Microsoft Corporation). As applicable, for individual animals, the maximum concentration (Cmax) in plasma, aqueous humor, retina, sclera/choroid-RPE (SCR), and vitreous humor and the time to reach maximum concentration (Tmax) were obtained by visual inspection of the raw data. Pharmacokinetic parameters calculated included half-life (ti_/2), area under the concentration-time curve from time 0 to the last measurable time point (AUCo-_t), and area under the concentration- time curve from 0 to infinity (AUCo-_∞). Pharmacokinetic parameters were calculated by using Phoenix Winnonlin, version 6.2.1 (Pharsight Corporation).

[00167] All animals appeared clinically healthy throughout acclimation and were released from acclimation and approved for use on the study.

[00168] Individual body weights, as well as calculated dose administered, are presented in Table 1. Individual body weights throughout the study are presented in Table 2. The suprachoroidal administration of CLSOl 1 A did not have a deleterious effect on body weight over the duration of the study.

[00169] Dosing observations are presented below. Following many of the injections, a small amount of test material (2-5 μL) was identified which may have been trapped under the conjunctiva or within the sclera upon needle withdrawal.

[00170] Clinical observations are presented in Table 3. Sporadic instances of low food consumption were noted throughout the study. Infrequent occurrences of these observations are considered normal for the species in a laboratory environment.

[00171] Individual indirect and slitlamp ophthalmic examination results are presented in

Table 4. The ophthalmology report is presented below.

[00172] All animals were free of ophthalmologic findings prior to test article administration. Suprachoroidal administration of CLS011A at 4 mg/eye (100 ^L/injection) was well tolerated through Study Day 91. Subconjunctival white plaques, likely representing test article were commonly observed at later intervals once the initial conjunctival response to the injection had resolved. The observed white plaques were consistent with the dosing observations above, indicating the plaques may be from the minor reflux into the subconjunctival space of CLS011A following dosing. Clear subconjunctival channels filled with a clear fluid were also observed in some eyes near the injection site on Study Day 15 and thereafter. Although the exact nature of these channels is unclear, they likely represent congested aqueous veins or lymphaticlike vessels. RPE pigment mottling was observed in one eye on Day 91 of the dosing phase, suggesting that this tissue was disturbed by the injection or test article.

[00173] Individual observations recorded at the time of tissue collection are listed in the following table:

[00174] White deposits were observed during tissue collections. Up to 61 days postdose, white deposits were observed on the exterior of the eye and could be removed with the bulbar conjunctiva. However, on Study Day 91, attempts were made to dislodge the white deposits from adhering to the sclera once the conjunctiva was removed. These attempts were unsuccessful, suggesting that the deposit was sub-scleral in location. It is possible the appearance of the deposits were more pronounced because the white test article is located between the translucent sclera and the deeply pigmented choroid. These white deposits were not seen upon examination of the fundus, indicating the deposit was most likely CLSOl 1 A located in the suprachoroidal space, which could be observed during external examination of the eyes.

[00175] Individual concentrations of CLSOl 1 A in plasma, aqueous humor, retina, sclera/choroid-RPE (SCR), and vitreous humor are presented in Tables 5-1 through 5-23. The concentrations of CLSOl 1 A were determined using using liquid chromatography with tandem mass spectrometric (LC-MS/MS) methods. Sample analysis was performed using a verified method. Analyst^® software (Version 1.6.2) was used to capture the LC-MS/MS data and integrate the peak areas. Watson LIMS software (Version 7.4.1) was used for data storage, management and reporting. Because the data were computer-generated and rounded appropriately for inclusion in the report, the use of reported values to calculate subsequent parameters will, in some instances, yield minor variations from those listed in the tables.

[00176] Abbreviations:

[00177] Table 5-1: Calibrator performance for CLSOllA in pigmented rabbit plasma

[00178] Table 5-2: Method linearity for CLSOllA in pigmented rabbit plasma

[00179] Table 5-3: Quality Control performance for CLSOllA in pigmented rabbit plasma

[00180] Table 5-4: Calibrator performance for CLSOllA in pigmented rabbit aqueous humor

[00181] Table 5-5: Method linearity for CLSOllA in pigmented rabbit aqueous humor

[00182] Table 5-6: Quality Control performance for CLSOllA in pigmented rabbit aqueous humor

[00183] Table 5-7: Calibrator performance for CLSOllA in pigmented rabbit retina

[00184] Table 5-8: Method linearity for CLSOllA in pigmented rabbit retina

[00185] Table 5-9: Quality Control performance for CLSOllA in pigmented rabbit retina

[00186] Table 5-10Calibrator performance for CLSOllA in pigmented rabbit SCR

[00188] Table 5-11: Method linearity for CLSOllA in pigmented rabbit SCR

Table 5-12: Quality Control performance for CLSOllA in pigmented rabbit

[00190] Table 5-13: Calibrator performance for CLSOllA in pigmented rabbit vitreous humor

Table 5-14: Method linearit for CLSOllA in i mented rabbit vitreous humor

[00191] Table 5-15: Quality Control performance for CLSOllA in pigmented rabbit vitreous humor

[00192] Study Results:

[00193] Table 5-16: Mean concentrations and percent recovery of CLSOllA in pigmented rabbit SCR

[00194] Table 5-17: Concentrations of CLSOllA (ng/mL) in pigmented rabbit plasma

[00195] Table 5-18: Concentrations of CLSOllA (ng/mL) in pigmented rabbit aqueous humor

Table 5-18 (continued): Concentrations of CLSOllA (ng/mL) in pigmented

[00197] Table 5-19:

Table 5-20:

Table 5-21:

[00200] Table 5-22:

[00201] Table 5-23:

[00202] The average concentration of plasma and mean concentrations of ocular tissues are presented in Tables 5 through 8. The mean concentrations of vitreous humor, sclera/choroid- RPE, and retina are presented graphically in FIG. 22. Pharmacokinetic analysis results are presented in Table 9.

[00203] Following suprachoroidal administration of CLSOl 1 A (4 mg/eye), the analyte was not observed at quantifiable levels (lower limit of quantitation = 1 ng/mL) in either plasma or aqueous humor samples throughout the durati on of the study. Conversely, CLSOl 1 A was quantifiable at all time points in vitreous humor, retina, and sclera/choroid-RPE (SCR).

[00204] As expected a concentration gradient was present with the dose depot (SCR) having 3-4 orders of magnitude higher concentrations than the retina, and the retina being 3-4 orders of magnitude higher than the vitreous humor. The dose depot (SCR) extrapolated initial concentration (Co) was 17.2 mg/g. The mean concentrations of CLSOl 1 A in the SCR rose slightly on Study Day 4, most likely due to interanimal variability. Concentrations of CLSOl 1 A started to decline beyond Study Day 8 through Study Day 91. The high levels of CLSOl 1 A remaining coincided with observation of sub-scleral white plaques, suggesting that the plaques were remaining dose depot. The elimination half-life (ti_/2) was calculated over the last 5 time points to be 102 days. This value should be interpreted with caution, as it was calculated over less than two times the half-life. The observed exposure (AUC₀._t) value of the dose depot was 1260 μg*day/g. Using the estimated ti_/2 an estimated total exposure (AUCo-_∞) value was calculated, however this value is not reported because more than 30% of the area has been extrapolated and the AUCo-_∞ value is not reliable.

[00205] Although CLSOl 1 A is dosed as a suspension, with limited solubility in aqueous solvent, the immediate presence of CLSOl 1 A 24 hours postdose in retina and vitreous humor indicates a type of burst release of the test article following dosing. The mean concentrations in retina and vitreous humor increased over time, to a maximal mean concentration (C_max) of 325 μg/g and 0.857 μg/mL, respectively. The C_max levels were reached in the vitreous humor on Study Day 4 (T_max), and then declined thereafter. The mean concentrations in retina were similar from Study Day 2 up to Study Day 15, and then increased approximately 3-fold on Study Day 29. The concentrations of CLSOl 1 A in retina remained consistent around the C_max until the last time point on Study Day 91. An elimination half-life (ti_/2) could not be calculated for retina and vitreous humor based on available data. The observed exposure to CLSOl 1 A (AUC₀._t) in retina and vitreous humor was aligned with the concentration gradient between the two tissues, with the retina exposure being nearly 4 orders of magnitude higher than vitreous humor. The retina concentrations of CLSOl 1 A remained above 44 μg/g throughout the duration of the study.

[00206] Conclusions: A single bilateral administration of CLSOl 1 A suspension was delivered to the suprachoroidal space through a microneedle in Dutch Belted male rabbits. Generally, CLSOl 1 A at 4 mg/eye (100 μL/injection) was well tolerated through Study Day 91. In a few animals, clear subconjunctival fluid-filled channels were observed sporadically near the injection site on Study Day 15 and thereafter. Additionally, RPE pigment mottling was observed in one eye on Day 91 of the dosing phase. The suprachoroidal administration of CLSOl 1 A did not have a deleterious effect on body weight and no overt signs of toxicity were observed.

[00207] Following many of the injections, small amount of test material may have been trapped under the conjunctiva or within the sclera upon needle withdrawal. The refluxed material may have appeared as subconjunctival white plaques to the examiner. In agreement with the postdose observations and exam findings, white deposits were observed during tissue collections. Up to 61 days postdose, white deposits were observed on the exterior of the eye and could be removed with the bulbar conjunctiva until Study Day 91, suggesting that the deposit was in part suprachoroidal in location.

[00208] Following a single bilateral suprachoroidal administration of CLSOl 1 A (4 mg/eye), the analyte was not observed at quantifiable levels in either plasma or aqueous humor samples. Conversely, CLSOl 1 A was quantifiable at all time points in vitreous humor, retina, and sclera/choroid-RPE (SCR). A concentration gradient of CLSOl 1 A in tissues was present, with the dose depot (SCR) the highest, followed by the retina, and finally the vitreous humor. The dose depot (SCR) concentrations of CLSOl 1 A were the highest early in the study, and then started to decline beyond Study Day 8 through Study Day 91. The high levels of CLSOl 1 A remaining coincided with observation of sub-scleral white plaques, suggesting that the plaques were remaining dose depot. The elimination half-life (t_1/2) was calculated to be 102 days, but this value should be interpreted with caution, as it was calculated over a period of less than two times the half-life. The observed exposure (AUCo-_t) value of the dose depot was 1260 μg*day/g. [00209] Although CLSOl lA is dosed as a suspension, with limited solubility in aqueous solvent, the immediate presence of CLSOl lA 24 hours postdose in retina and vitreous humor indicated a burst release of the test article into tissue following dosing. CLSOl 1 A levels in retina and vitreous humor increased over time, to a maximal mean concentration (C_max) of 325 μg/g and 0.857 μg/mL, respectively. The Cmax levels were reached in the vitreous humor on Study Day 4 (Tmax), and then declined thereafter albeit with some variability. The mean concentrations in retina were similar from Study Day 2 up to Study Day 15, and then increased approximately 3-fold on Study Day 29. The concentrations of CLSOl lA in retina were similar to the Cma_X through Study Day 91. The observed exposure to CLSOl lA (AUCo-t) in retina and vitreous humor was consistent with the concentration gradient between the two tissues. The retina concentrations of CLSOl 1 A remained above 44 μg/g throughout the duration of the study.

[00210] Table 1: Individual body weights and doses administered to male Dutch Belted rabbits dosed via suprachoroidal injection with Axitinib

[00211] Table 3

[00212] Table 4:

[00213] Table 5: Average plasma concentrations (ng/mL) in male Dutch Belted rabbits dosed via suprachoroidal injection with Axitinib

[00214] Table 6: Mean aqueous humor concentrations (ng/mL) in male Dutch Belted rabbits dosed via suprachoroidal injection with Axitinib

[00215] Table 6: Mean vitreous humor concentrations (ng/mL) in male Dutch Belted rabbits dosed via suprachoroidal injection with Axitinib

[00216] Table 7: Mean sclera/choroid-RPE (SCR) concentrations (ng/g) in male Dutch Belted rabbits dosed via suprachoroidal injection with Axitinib

[00217] Table 8: Mean retina concentrations (ng/g) in male Dutch Belted rabbits dosed via suprachoroidal injection with Axitinib

[00218] Table 9: Mean pharmacokinetic parameters in retina, sclera/choroid-RPE, and vitreous humor of male Dutch Belted rabbits dosed via suprachoroidal injection with Axitinib

Example 3. 2-Week Ocular Tolerance Study Following Suprachoroidal Administration with CLS011A in Rabbits

[00219] The objective of this study was to evaluate the tolerability of the test article, CLS011A (axitinib) in vehicle (0.5% NaCMC [carboxylmethylcellulose sodium], 0.04% Polysorbate 80, 10 mM Phosphate Buffer, 0.8% NaCl) following a single unilateral suprachoroidal microneedle injection to rabbits; after dosing, animals were observed for 14 days (Day 15 terminal sacrifice) to assess the reversibility, persistence, or delayed occurrence of effects.

[00220] Methods:

[00221] Test System and Study Design:

[00222] Species Selection and Dose Administration Rationale: Rabbits historically have been used in safety evaluation studies and are recommended by appropriate regulatory agencies. The suprachoroidal route of administration was selected because it is the intended route of administration in humans.

[00223] Animal Specifications and Acclimation: Fifteen male Hra:(NZW) SPF rabbits were received and twelve animals were assigned to the study. Animals were acclimated for two weeks (predose phase). At initiation of dosing, animals were 18 weeks old, and body weights ranged from 2212 to 2844 g. Animals not used on study were placed in the stock colony.

[00224] Environmental Conditions, Diet, and Water: Animals were housed individually in stainless steel cages. Water was provided ad libitum. Animals were presented with increasing amounts of Certified Rabbit Diet #5325 (PMI Nutrition International Certified LabDiet®) once daily during the first week following arrival until acclimated to approximately 150 g/day. Animals were maintained on approximately 150 g/day until study termination. Environmental controls were set to maintain the following animal room conditions: temperature range of 16 to 22°C, relative humidity range of 30 to 70%, 10 or greater air changes/hour, and a 12-hour light/12-hour dark cycle. The light/dark cycle was interrupted for study-related activities. Any variations to these conditions are maintained in the raw data and had no effect on the outcome of the study. Animals were given various cage-enrichment devices and dietary enrichment (that did not require analyses).

[00225] Animal Identification and Assignment to Study: Animals were identified using a tattoo, implantable microchip identification device, and cage card. Animals were assigned to the study using a computerized procedure designed to achieve body weight balance with respect to group assignment. Prior to group assignment, animals were excluded from the selection pool to produce minimal variation. After group assignment, the mean body weight for each group was not statistically different at the 5.0% probability level, as indicated by analysis of variance F probability.

[00226] Study Design:

[00227] Test Article and Vehicle Control Article/Diluent: Information on synthesis methods, stability, purity, composition, or other characteristics defining the test and vehicle control articles is on file with the sponsor or the respective manufacturer. The test article, CLS011A (axitinib), was provided by the sponsor pre-formulated at a concentration of 40 mg/mL. The vehicle control article/diluent was 0.5%> NaCMC (carboxymethylcellulose sodium), 0.04%. Polysorbate 80, 10 mM Phosphate Buffer, and 0.8%. NaCl provided preformulated by the sponsor as Vehicle for CLSOl 1 A.

[00228] Test Article and Vehicle Control Article/Diluent Formulation: Test article and vehicle control article formulations were prepared by Covance according to the mixing procedure using aseptic procedures under a laminar flow hood once on the day of dosing. Dose concentrations were based on the test article as supplied. Vehicle control article/diluent was used as supplied by the sponsor to dose Group 1 and dispensed using aseptic procedures, he test article, provided at 40 mg/mL, was used as supplied to dose Group 4, and was diluted (v:v) with the vehicle control article/diluent to the appropriate concentrations to dose Groups 2 and 3. The test article stock was vortexed to create a visually uniform suspension prior to further dispensation or dilution. Dosing suspensions were drawn up into a Clearside microinjector (1-mL luer-lock) syringe using a standard 21 -gauge, 1-inch needle; any bubbles were expressed, and the standard needle was replaced by a 30 gauge microneedle 700 μm in length for dosing. Dosing solutions were maintained under ambient conditions prior to filling syringes. Filled syringes were maintained under ambient conditions prior to dosing.

[00229] Bioanalytical and Toxicokinetic Analysis:

[00230] Bioanalytical Sample Collection and Handling: Blood samples (approximately 2.0 mL) were collected via jugular vein or auricular ear artery on Day 1 of the dosing phase. Samples were collected predose and approximately 30 minutes, 1, 2, 4, 12, and 24 hours postdose. Blood was collected into tubes containing potassium (K2) EDTA. Samples were maintained on chilled cryoracks and centrifuged within 1 hour of collection. Plasma was harvested and stored in a freezer, set to maintain -60 to -80°C, until analyzed.

[00231] Bioanalytical Analysis: Plasma analysis for the test article (CLS011A) was performed by the Covance-Madison Discovery Bioanalytical Department using an established discovery-grade LC-MS/MS method.

[00232] Toxicokinetic Analysis: Toxicokinetic analyses were not conducted.

[00233] Inlife Procedures:

[00234] Dose Administration: Dose formulations were administered to the right eye of each animal by single suprachoroidal injection at a volume of 100 μL/eye on Day 1 of the dosing phase. Dosing was done by OSOD with assistance from Covance staff. Prior to the injections, animals were anesthetized. A topical anesthetic (0.5% proparacaine) was instilled in each dosed eye before the first dosing. The eyes were cleaned with a dilute, -1% povidone iodine solution and rinsed with sterile saline prior to the first dosing. The periorbital region was cleaned with a dilute, -1% povidone iodine solution. A single suprachoroidal injection of 100 μL, given over approximately 5-10 seconds was administered to each right eye (5 mm from the limbus, in the superior temporal quadrant) by OSOD according to a study-specific procedure. Following the injection, the needle was kept in the eye for approximately 30 seconds before being withdrawn. Upon withdrawal of the microneedle, a cotton-tipped applicator was placed over the injection site for approximately 10 seconds. The eye was inspected to confirm accuracy of injection by OSOD and dosing observations were recorded.

[00235] Medication Regimen: A treatment regimen was put in place on the day of dosing to provide palliative treatment related to the dosing procedures. Prior to sedation for dosing, flunixin meglumine, a nonsteroidal antiinflammatory drug was administered at a dose of 2 mg/kg by intramuscular injection. Upon recovery from anesthesia, buprenorphine SR, a sustained- release semi -synthetic opioid, was administered at a dose level of 0.2 mg/kg by subcutaneous injection. Additionally, a bland ophthalmic ointment was applied postdose as needed.

[00236] Clinical Observations:

[00237] Health Monitoring: Animals were checked twice daily (a.m. and p.m.) for mortality, abnormalities, and signs of pain or distress. Abnormal findings were recorded as observed.

[00238] Clinical Examinations: Cageside observations were conducted for each animal once daily during the predose and dosing phases, except on days when detailed observations were conducted. Abnormal findings were recorded as observed. Detailed observations were conducted for each animal two to three times during the predose phase, prior to dosing on Day 1, and weekly (based on Day 1) throughout the dosing phase. Abnormal findings or an indication of normal was recorded.

[00239] Body Weights: Body weights were recorded for each animal two to three times during the predose phase, prior to dosing on Day 1, and weekly (based on Day 1) throughout the dosing phase. The adnexa and anterior portion of both eyes was examined using a slit lamp biomicroscope. The ocular fundus of both eyes was examined using an indirect ophthalmoscope. Prior to examination with the indirect ophthalmoscope, the eyes were dilated with a mydriatic agent (1% tropicamide). [00240] Intraocular Pressures: Intraocular pressure (IOP) measurements were conducted were conducted by OSOD in conjunction with OE using a rebound tonometer once during the predose phase and on Days 3, 8, and 15 of the dosing phase. On days of OE, IOP measurements were conducted on eyes that had been pharmacologically dilated.

[00241] Clinical Laboratory Procedures:

[00242] Clinical Pathology:

[00243] Sample Collection and Handling: Blood samples for hematology, coagulation, and clinical chemistry were collected via a jugular vein or auricular ear artery jugular vein once during the predose phase. The anticoagulants were sodium citrate for coagulation tests and potassium EDTA for hematology tests. Samples for clinical chemistry were collected without anticoagulant.

[00244] Hematology Tests

[00245] Coagulation Tests

[00246] Clinical Chemistry Tests

[00247] Terminal Procedures:

[00248] Necropsy and Macroscopic Observations: On Day 15 of the dosing phase, all surviving animals were anesthetized with sodium pentobarbital, exsanguinated, and necropsied. Terminal body weights were not recorded. An examination of the external features of the carcass; external body orifices; abdominal, thoracic, and cranial cavities; organs; and tissues was performed. At scheduled sacrifices, macroscopic examinations were conducted. The following tissues (when present) from each animal were preserved in 10% neutral -buffered formalin unless otherwise indicated.

[00249] Histology: As indicated in the previous table (Necropsy and Macroscopic Observations section), tissues from each animal were embedded in paraffin, sectioned, and slides were prepared and stained with hematoxylin and eosin. Sections to include the dose site (when visible), medullary ray, and optic disc were prepared.

[00250] Microscopic Observations: Tissues indicated in the previous table (Necropsy and Macroscopic Observations section) from all animals were examined microscopically by the contributing scientist for anatomic pathology. [00251] Data Evaluation and Statistical Analysis: Various models of calculators, computers, and computer programs were used to analyze data in this study. Values in some tables (e.g., means, standard deviations, or individual values) may differ slightly from those in other tables, from individually calculated data, or from statistical analysis data because different models round off or truncate numbers differently. Neither the integrity nor the interpretation of the data was affected by these differences.

[00252] Due to the small number of animals in the study design, statistical data analyses were limited to the calculation of means and standard deviations (no hypothesis testing, such as regression or group comparisons, was performed). Means and standard deviations were calculated for the following parameters: absolute body weight; body weight change; and IOP data.

[00253] Results:

[00254] Bioanalysis: CLSOl 1 A was detected in two plasma samples collected at one hour postdose administration (Animal No. F35706 given 1.5 mg/right eye and Animal No. F35711 given 4 mg/right eye). All other samples were below the limit of quantification.

[00255] Inlife Evaluations:

[00256] Animal Fate: Animal fate data are presented in Table lOError! Reference source not found..

0257] Table 10: Individual Clinical Observations

[00258] Clinical Observations: Clinical observations data are summarized in Table 11; individual data are presented in Table 12.

[00259] Table 11: Summary of Clinical Observations

[00260] Table 12: Individual Animal Fate

[00261] CLSOl 1 A did not have an effect on clinical observations. Ocular-related findings in all groups included red conjunctivae of the right eye noted on Day 1 of the dosing phase and dilated pupils of both eyes noted through Day 2 of the dosing phase. These were considered related to the dosing procedure and not the test article because they were noted in animals given the vehicle control article at the same incidence as animals given the test article. Other clinical observations were also noted but they were not considered test article-related because they were noted at a similar incidence in animals given the vehicle control article and are frequently observed in laboratory animals.

[00262] Body Weights: CLSOl 1 A did not have an effect on body weight or body weight change.

[00263] Ophthalmic Examinations: Ophthalmic findings are presented in the

Ophthalmology Report.

[00264] Predose Examination Findings: All animals used in the dosing phase had a normal ophthalmic examination at the predose interval.

[00265] Dosing Phase Examination Findings: No findings were noted in un-dosed left eyes in any Group throughout the dosing phase. The following summarizes the findings in right eyes. [00266] Dosing Phase Examination Findings - Group 1 (Vehicle Control right eye, un-dosed left eye): On Day 3 of the dosing phase, findings consisted of mild (1+) conjunctival hyperemia in all three right eyes and mild (1+) chemosis in one right eye. These findings resolved without complication by the next examination on Day 8 of the dosing phase.

[00267] Dosing Phase Examination Findings - Group 2 (0.4 mg/right eye, un-dosed left eye): The only ophthalmic examination finding occurred on Day 15 of the dosing phase, in which small white subconjunctival plaques were present near the superior-temporal fornix in all three right eyes. These plaques were believed to represent the test article.

[00268] Dosing Phase Examination Findings - Group 3 (1.5 mg/right eye, un-dosed left eye): On Day 3 of the dosing phase, findings consisted of mild (1+) conjunctival hyperemia in one eye. On Days 8 and 15, small white subconjunctival plaques were noted near the superior-temporal fornix in Animal Nos. F35707 and F35709. On Day 15 of the dosing phase, a focal area of chemosis was noted at the injection site (and overlying the white subconjunctival plaque) in Animal No. F35709.

[00269] Dosing Phase Examination Findings - Group 4 (4.0 mg/right eye, un-dosed left eye): On Day 3 of the dosing phase, all three right eyes had mild (1+) conjunctival hyperemia and mild (1+) chemosis. A white subconjunctival plaque was present near the superior-temporal fornix in one right eye. On Day 8 of the dosing phase, findings consisted of mild (1+) conjunctival hyperemia in one eye and white subconjunctival plaques near the superior-temporal fornix in two eyes. On Day 15 of the dosing phase, findings consisted of white subconjunctival plaques near the superior-temporal fornix in all three right eyes and a focal area of chemosis at the injection site (and overlying the white subconjunctival plaque) in Animal No. F35711.

[00270] The white subconjunctival plaques correlated with the infiltrates of vacuolated macrophages noted on histological evaluation (see Microscopic Observations section). These plaques were more frequently recognized over time although it is unclear whether this was attributable to improved visibility due to a reduction in the ocular surface response to the injection itself, an improved ability over time to visualize the superior-temporal fornix area (due to less squinting by the animal during the examination) or if it was due to an increase in the amount of material in the plaque over time.

[00271] Intraocular Pressure Measurements: ntraocular pressure data are presented in the Ophthalmology Report. Formal statistical analysis of IOP data was not performed for this study due to the limited numbers of animals/group. Nevertheless certain observations can be made 1) IOP values in the predose and dosing phase were within the expected normal limits for this species with this tonometer; 2); no clear and consistent IOP differences were noted between eyes administered the vehicle control or test article at any of the three dose levels.

[00272] Terminal Evaluations: Macroscopic and microscopic observations and findings are presented in the Anatomic Pathology Report.

[00273] Macroscopic Observations: All animals given the CLS011A were macroscopically unremarkable.

[00274] Microscopic Observations: A test article-related microscopic finding of minimal or slight infiltrates of vacuolated choroidal/suprachoroidal macrophages occurred in the dosed (right) eye of all animals given CLS011A (axitinib). Vacuolated macrophages were characterized by infiltration in the superior choroid/suprachoroid near the injection site, but also extended more diffusely into the choroid/suprachoroid throughout the remainder of the globe, into the perivascular spaces of the sclera, and/or into the lamina cribrosa and epibulbar connective tissue, which is adjacent to the optic nerve in some animals, and were sometimes seen in conjunction with occasional inflammatory cells. The vacuolated macrophages correlated with the white subconjunctival plaques noted during ophthalmic examinations (see Ophthalmic Examinations section). No microscopic findings considered injection procedure-related or vehicle-related occurred in the right eye of control animals. Findings are summarized in Table 13. Table 13: Incidence and Severity of Test Article-Related Microscopic

[00276] All other microscopic findings in the right eye and all microscopic findings in the left eye were considered spontaneous and/or incidental because they occurred at a low incidence and their severity was as expected for Hra:(NZW)SPF rabbits of this age; therefore, they were not considered test article-related. No microscopic findings occurred in the left or right bulbar conjunctiva.

[00277] Conclusion: In conclusion, suprachoroidal administration of CLS011A in the vehicle control article (0.5% NaCMC (carboxymethylcellulose sodium), 0.04% Polysorbate 80, 10 mM Phosphate Buffer, and 0.8% NaCl) to male New Zealand White rabbits at a dose level of 0.4, 1.5, or 4.0 mg/right eye was well tolerated. CLSOl lA-related ophthalmic observations included subconjunctival plaques in the superior-temporal quadrant near the dose site in right eyes of animals given≥0.4 mg/right eye and microscopic findings included minimal to slight infiltrates of choroidal/suprachoridal vacuolated macrophages in the right eyes of animals given ≥0.4 mg/right eye. The vacuolated macrophages were most often located near the injection site but also extended more diffusely. Example 4. Preclinical Pharmacokinetic Study of Coular Distribution and Duration of Axitinib in Rabbit Model

[00278] A preclinical pharmacokinetic study was conducted to assess the rate at which axitinib distriburtes through the ocular tissues, in addition to the time-frame of such ocular distribution.

[00279] Results: See Fig. 23.

[00280] CLSOllA Concentration:

Example 5. PK Study to Determine Scale of Residence Time of Axitinib Drug Suspension in the Eye

[00281] Purpose: To determine the concentrate concentration and mass of axitinib in entire: (a) sclera/choroid/retina, (b) vitreous, and (c) plasma.

[00282] Time points after injection: 5-10 minutes after injection; 6 hours after injection;

24 hours (1 day) after injection; 3 days after injection; 7 days after injection.

[00283] Study Design:

[00284] Results: See FIGs. 24-31. [00285] Conclusions:

Example 6. Axitinib Formulation

[00286] An axinib formulation exhibiting superior redispersability and processing was generated. In this formulation, described in the table below, for a 40 mg/mL axitinib formulation, the amount of Polysorbate 80 was adjusted to 0.1% w/v; the amount of phosphate buffer was adjusted to 0.059% w/v; and the amount of sodium chloride was adjusted to 0.79% w/v. The increase in Polysorbate 80 increased redispersability of the material. The increase in phosphate buffer allowed more efficient processing of the material. For example, buffers can be included without the need to adjust pH using the adjusted amounts of the materials. The sodium chloride concentration was adjusted to maintain isotonicity in the formulation.

[00287] Publications, patents and patent applications cited herein are specifically incorporated by reference in their entireties. While the described invention has been described with reference to the specific embodiments thereof it should be understood by those skilled in the art that various changes may be made and equivalents may be substituted without departing from the true spirit and scope of the invention. In addition, many modifications may be made to adopt a particular situation, material, composition of matter, process, process step or steps, to the objective spirit and scope of the described invention. All such modifications are intended to be within the scope of the claims appended hereto.

Claims

1. A method of treating wet age-related macular degeneration (AMD), choroidal neovascularization (CNV), wet AMD associated with CNV or wet AMD associated with RVO in a human subject in need thereof, the method comprising,

in a dosing session, non-surgically administering an effective amount of a tyrosine kinase inhibitor formulation to the suprachoroidal space (SCS) of the eye of the human subject in need of treatment,

wherein upon administration, the tyrosine kinase inhibitor formulation flows away from the insertion site and is substantially localized to the posterior segment of the eye.

2. The method of claim 1, wherein the tyrosine kinase inhibitor is a vascular endothelial growth factor (VEGF) antagonist.

3. The method of claim 1 or 2, wherein the tyrosine kinase inhibitor is a platelet derived growth factor (PDGF) antagonist.

4. The method of any one of claims 1-3, wherein the tyrosine kinase inhibitor is axitinib.

5. The method of claim 1, wherein the tyrosine kinase inhibitor is Alectinib (Alecensa®), angiokinase inhibitors such as Nintedanib (Vargatev®), Afatinib (Gilotrif®), and Motesanib, Apatinib, Axitinib, Cabozantinib (Cometriq®), Canertinib, Crenolanib, Damnacanthal, Foretinib, Fostamatinib; growth factor receptor inhibitor, Ibrutinib (Imbruvica®), Icotinib, Imatinib (Gleevec®), Linifanib, Mubritinib, Radotinib, T790M, V600E, Vatalanib, Vemurafenib (Zelboraf®), AEE788 (TKI, VEGFR-2, EGFR: Novartis), ZD6474 (TKI, VEGFR-1, -2, -3, EGFR: Zactima: AstraZeneca), AZD2171 (TKI, VEGFR-1, -2: AstraZeneca), SU 11248 (TKI, VEGFR-1, -2, PDGFR: Sunitinib: Pfizer), AG13925 (TKI, VEGFR-1, -2: Pfizer), AGO 13736 (TKI, VEGFR-1, -2: Pfizer), CEP-7055 (TKI, VEGFR-1, -2, -3 : Cephalon), CP-547,632 (TKI, VEGFR-1, -2: Pfizer), GW7S6024 (TKL VEGFR-1, -2, -3 : GlaxoSmithKline), GW786034 (TKI, VEGFR-1, -2, -3 : GlaxoSmithKline), sorafenib (TKI, Bay 43-9006, VEGFR-1, -2, PDGFR: Bayer/Onyx), SU4312 (TKI, VEGFR-2, PDGFR: Pfizer), AMG706 (TKI, VEGFR-1, - 2, -3 : Amgen), XL647 (TKI, EGFR, HER2, VEGFR, ErbB4: Exelixis), XL999 (TKI, FGFR, VEGFR, PDGFR, FII-3 : Exelixis), PKC412 (TKI, KIT, PDGFR, PKC, FLT3, VEGFR-2: Novartis), AEE788 (TKI, EGFR, VEGFR2, VEGFR- 1 : Novartis): OSI-030 (TKI, c-kil, VEGFR: OSI Pharmaceuticals), OS1-817 (TKI c-kit, VEGFR: OSI Pharmaceuticals), DMPQ (TKI, ERGF, PDGFR, ErbB2. p56. pkA, pkC), MLN518 (TKI, Flt3, PDGFR, c-KIT (T53518: Millennium Pharmaceuticals), lestaurinib (TKI, FLT3, CEP-701, Cephalon), ZD 1839 (TKI, EGFR: gefitinib, Iressa: AstraZcneca), OSI-774 (TKI, EGFR: Erlotininb: Tarceva: OSI Pharmaceuticals), or lapatinib (TKI, ErbB-2, EGFR, and GD-2016: Tykerb: GlaxoSmithKline).

6. The method of any one of claims 1-5, further comprising non-surgically administering a second drug to the eye of the patient.

7. The method of claim 6, wherein the second drug is present in the tyrosine kinase inhibitor formulation.

8. The method of claim 6, wherein the second drug is present in a second drug formulation and is administered intravitreally.

9 The method of any one of claims 6-8, wherein the second drug is a VEGF modulator.

10. The method of claim 9, wherein the VEGF modulator is a VEGF antagonist.

11. The method of claim 10, wherein the second drug is a VEGF antagonist selected from a VEGF-receptor kinase antagonist, an anti-VEGF antibody or fragment thereof, an anti-VEGF receptor antibody, an anti-VEGF aptamer, a small molecule VEGF antagonist, a thiazolidinedione, a quinoline or a designed ankyrin repeat protein (DARPin).

12. The method of claim 10, wherein the VEGF antagonist is aflibercept, ziv-aflibercept, bevacizumab, sonepcizumab, VEGF sticky trap, cabozantinib, foretinib, vandetanib, nintedanib, regorafenib, cediranib, ranibizumab, lapatinib, sunitinib, sorafenib, plitidepsin, regorafenib, verteporfin, bucillamine, axitinib, pazopanib, fluocinolone acetonide, nintedanib, AL8326, 2C3 antibody, AT001 antibody, XtendVEGF antibody, HuMax-VEGF antibody, R3 antibody, AT001/r84 antibody, HyBEV, ANG3070, APX003 antibody, APX004 antibody, ponatinib, BDM-E, VGX100 antibody, VGX200, VGX300, COSMIX, DLX903/1008 antibody, ENMD2076, INDUS815C, R84 antibody, KD019, NM3, MGCD265, MG516, MP0260, NT503, anti -DLL4/VEGF bispecific antibody, PAN90806, Palomid 529, BD0801 antibody, XV615, lucitanib, motesanib diphosphate, AAV2-sFLT01, soluble Fltl receptor, AV-951, Volasertib, CEP11981, KH903, lenvatinib, lenvatinib mesylate, terameprocol, PF00337210, PRS050, SP01, carboxyamidotriazole orotate, hydroxychloroquine, linifanib, ALG1001, AGN150998, MP0112, AMG386, ponatinib, PD173074, AVA101, BMS690514, KH902, golvatinib (E7050), dovitinib, dovitinib lactate (TKI258, CHIR258), ORA101, ORA102, Axitinib (Inlyta, AG013736), PTC299, pegaptanib sodium, troponin, EG3306, vatalanib, BmablOO, GSK2136773, Anti- VEGFR Alterase, Avila, CEP7055, CLT009, ESBA903, GW654652, HMPL010, GEM220, HYB676, JNJ17029259, TAK593, Nova21012, Nova21013, CP564959, smart Anti-VEGF antibody, AG028262, AG13958, CVX241, SU14813, PRS055, PG501, PG545, PTI101, TG100948, ICS283, XL647, enzastaurin hydrochloride, BC194, COT601M06.1, COT604M06.2, MabionVEGF, Apatinib, RAF265 (CHIR-265), Motesanib Diphosphate (AMG-706), Lenvatinib (E7080), TSU-68 (SU6668, Orantinib), Brivanib (BMS-540215), MGCD-265, AEE788 (NVP- AEE788), ENMD-2076, OSI-930, CYC116, ΚΪ8751, Telatinib, KRN 633, SAR131675, Dovitinib (TKI-258) Dilactic Acid, Apatinib, BMS-794833, Brivanib Alaninate (BMS-582664), Golvatinib (E7050), Semaxanib (SU5416), ZM 323881 HC1, Cabozantinib malate (XL184), ZM 306416, AL3818, AL8326, 2C3 antibody, AT001 antibody, HyBEV, bevacizumab (Avastin®), ANG3070, APX003 antibody, APX004 antibody, ponatinib (AP24534), BDM-E, VGX100 antibody (VGX100 CIRCADIAN), VGX200 (c-fos induced growth factor monoclonal antibody), VGX300, COSMIX, DLX903/1008 antibody, ENMD2076, sunitinib malate (Sutent®), INDUS815C, R84 antibody, KD019, NM3, allogenic mesenchymal precursor cells combined with an anti-VEGF antagonist (e.g., anti-VEGF antibody), MGCD265, MG516, VEGF-Receptor kinase inhibitor, MP0260, NT503, anti -DLL4/ VEGF bispecific antibody, PAN90806, Palomid 529, BD0801 antibody, XV615, lucitanib (AL3810, E3810), AMG706 (motesanib diphosphate), AAV2-sFLT01, soluble Fltl receptor, cediranib (Recentin™), AV-951, tivozanib (KRN-951), regorafenib (Stivarga®), volasertib (BI6727), CEP11981, KH903, lenvatinib (E7080), lenvatinib mesylate, terameprocol (EM1421), ranibizumab (Lucentis®), pazopanib hydrochloride (Votrient™), PF00337210, PRS050, SP01 (curcumin), carboxyamidotriazole orotate, hydroxychloroquine, linifanib (ABT869, RG3635), fluocinolone acetonide (Iluvien®), ALG1001, AGN150998, DARPin MP0112, AMG386, ponatinib (AP24534), AVA101, nintedanib (Vargatef™), BMS690514, KH902, golvatinib (E7050), everolimus (Afinitor®), dovitinib lactate (TKI258, CHIR258), ORA101, ORA102, axitinib (Inlyta®, AGO 13736), plitidepsin (Aplidin®), PTC299, aflibercept (Zaltrap®, Eylea®), pegaptanib sodium (Macugen™, LI900015), verteporfin (Visudyne®), bucillamine (Rimatil, Lamin, Brimani, Lamit, Boomiq), R3 antibody, AT001/r84 antibody, troponin (BLS0597), EG3306, vatalanib (PTK787), BmablOO, GSK2136773, Anti-VEGFR Alterase, Avila, CEP7055, CLT009, ESBA903, HuMax-VEGF antibody, GW654652, HMPL010, GEM220, HYB676, JNJ17029259, TAK593, XtendVEGF antibody, Nova21012, Nova21013, CP564959, Smart Anti-VEGF antibody, AG028262, AG13958, CVX241, SU14813, PRS055, PG501, PG545, PTI101, TG100948, ICS283, XL647, enzastaurin hydrochloride (LY317615), BC194, quinolines, COT601M06.1, COT604M06.2, MabionVEGF, SIR-Spheres coupled to anti-VEGF or VEGF-R antibody, Apatinib (YN968D1), or AL3818.

13. The method of claim 10, wherein the VEGF antagonist is aflibercept.

14. The method of any one of claims 1-13, wherein subsequent to the dosing session in the eye in need of treatment, the patient experiences a decrease in retinal thickness in the treated eye, as measured by optical coherence tomography (OCT) compared to the patient's retinal thickness in the eye in need of treatment prior to the dosing session.

15. The method of claim 14, wherein the retinal thickness is central subfield thickness (CST).

16. The method of claim 14 or 15, wherein the decrease in retinal thickness is≥ 25 μm,≥ 50 μm,≥ 75 μm or≥ 100.

17. The method of any one of claims 14-16, wherein the decrease in retinal thickness is≥ 5%,≥ 10% or≥ 25%.

18. The method of any one of claims 14-17, wherein the decrease in retinal thickness is measured at least about 1 week, at least about 2 weeks, at least about 1 month, at least about 2 months, at least about 3 months or at least about 4 months subsequent to the dosing session.

19. The method of any one of claims 1-18, wherein subsequent to a dosing session, the patient substantially maintains his or her vision, as measured by losing fewer than 15 letters in a best-corrected visual acuity (BCVA) measurement, compared to the patient's BCVA measurement prior to the dosing session.

20. The method of any one of claims 1-19, wherein the patient experiences an improvement in vision subsequent to a dosing session, as measured by gaining≥ 5 letters,≥ 10 letters or≥ 15 letters in a best-corrected visual acuity (BCVA) measurement, compared to the patient's BCVA prior to the dosing session.

21. A formulation comprising axitinib, and Polysorbate 80, wherein the formulation comprises axitinib particles having a D50 of about Ι μm to about 2μm.

22. The formulation of claim 21, wherein the particles have a D10 of less than about Ι μm.

23. The formulation of claim 21, wherein the particles have a D90 of about 3μm to about 5μm.

24. The formulation of claim 21, wherein the formulation further comprises carboxymethylcellulose sodium, sodium chloride, and sodium phosphate.

25. The formulation of claim 21, wherein the formulation comprises from about 0. 25% w/v to about 0.2% w/v Polysorbate 80.

26. The formulation of claim 25, wherein the formulation comprises about 0.1% w/v Polysorbate 80.

27. The formulation of claim 26, wherein the formulation comprises about about 0.059% w/v sodium phosphate (monobasic monohydrate), about 0.079%) sodium phosphate (dibasic, anhydrous), about 0.79% w/v sodium chloride, about 0.5% carboxymethylcellulose sodium, and water.