Fouling in ocular devices: implications for drug delivery, bioactive surface immobilization, and biomaterial design


The last 30 years has seen a proliferation of research on protein-resistant biomaterials targeted at designing bio-inert surfaces, which are prerequisite for optimal performance of implantable devices that contact biological fluids and tissues. These efforts have only been able to yield minimal results, and hence, the ideal anti-fouling biomaterial has remained elusive. Some studies have yielded biomaterials with a reduced fouling index among which high molecular weight polyethylene glycols have remained dominant. Interestingly, the field of implantable ocular devices has not experienced an outflow of research in this area, possibly due to the assumption that biomaterials tested in other body fluids can be translated for application in the ocular space. Unfortunately, progression in the molecular understanding of many ocular conditions has brought to the fore the need for treatment options that necessitates the use of anti-fouling biomaterials. From the earliest implanted horsehair and silk seton for glaucoma drainage to the recent mini telescopes for sight recovery, this review provides a concise incursion into the gradual evolution of biomaterials for the design of implantable ocular devices as well as approaches used to overcome the challenges with fouling. The implication of fouling for drug delivery, the design of immune-responsive biomaterials, as well as advanced surface immobilization approaches to support the overall performance of implantable ocular devices are also reviewed.

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Adapted from Adv. Drug Deliv. Rev., vol. 128, pp. 148–157, H. Kaji, N. Nagai, M. Nishizawa, and T. Abe, “Drug delivery devices for retinal diseases,” Copyright (2018) with permission from Elsevier [40]

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Microelectromechanical systems


Diabetic macular edema


Age-related macular degeneration


Foreign body response


Glaucoma drainage device


Tissue factor


Polymorphonuclear leucocytes


Anterior chamber-associated immune deviation


Reactive oxygen species


Toll-like receptors


Pattern recognition receptor


High mobility group box 1


Monocyte chemotactic protein

MIP 1β:

Macrophage inflammatory protein 1β


Dendritic cells


Contact lens

IPN or ipn:

Interpenetrating polymer networks


2-Methacryloyloxyethyl phosphorylcholine


Poly(2-methacryloyloxyethyl) phosphorylcholine


Poly(bis(trimethylsilyloxy)methylsilylpropyl glycerol methacrylate)


Intraocular lens


Anterior capsular opacification


Posterior capsule opacification


Fibroblast growth factor


Layer by layer


Anterior subcapsular cataract


Minimally invasive glaucoma surgery






Glaucoma filtration surgery


2-(Methacryloyloxy)ethyl-[N-(methacryloyloxy)ethyl phosphorylcholine


Bovine serum albumin


First in humans


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This work was supported by the National Research Foundation (NRF) of South Africa, South African Medical Research Council (SAMRC), and the University of the Witwatersrand, Johannesburg.

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O.J.U., P.K., V.P., and Y.E.C. planned the review; O.J.U. conducted the literature search and wrote the first draft; P.K., V.P., and Y.E.C. reviewed and revised the manuscript; all authors provided input to the reviewer comments and approved the final version.

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Correspondence to Yahya E. Choonara.

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Uwaezuoke, O.J., Kumar, P., Pillay, V. et al. Fouling in ocular devices: implications for drug delivery, bioactive surface immobilization, and biomaterial design. Drug Deliv. and Transl. Res. (2021).

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  • Biomaterials
  • Ocular
  • Fouling
  • Protein adsorption
  • Implantable device
  • Drug delivery
  • Immune responsive