Prevention of Staphylococcus epidermidis Endophthalmitis by Different Moxifloxacin Prophylaxis Routes.

BACKGROUND: To investigate postoperative endophthalmitis (POE) prevention by moxifloxacin prophylaxis. METHODS: After crystalline lens removal and intraocular lens (IOL) implantation, 18 rabbit eyes were injected intracameral with different coagulase negative staphylococci (CNS) inoculums in order to determine the minimum inoculum required for a reproducible POE model. Another 28 similar eyes were divided into Group A, which was implanted with standard IOLs with intracameral injection of 100 µg/0.1 ml moxifloxacin, Group B implanted with moxifloxacin presoaked IOLs, Group C treated as Groups A and B, and Group D (control) implanted with standard IOLs only. At the end of surgery, all eyes were injected with the minimal inoculum that had developed POE, and treated with topical moxifloxacin for 24 hours. They were then evaluated using 3 different POE scores. RESULTS: The minimum CNS concentration that developed reproducible POE was 5x10(5) CFUs/0.1 ml. Scores: 1. Clinical endophthalmitis was judged in 5/7 (71%), 4/7 (57%), 2/7 (28%) and 7/7 (100%) of Groups A-D eyes, respectively, p=0.005 and 0.057 for Groups B and C compared to D, respectively. 2. Endophthalmitis Scores for Groups A-D were 14.5±6.8, 10.6±4.5, 12.0±3.9 and 18.6±1.7, respectively, p=0.015, and ~0.07 for Groups B and C compared to D, respectively. 3. Hypoyon was noted in 2/6 (33%), 2/7 (28%), 2/7 and 6/7 (86%) of the Group A-D eyes, respectively, p=0.053, 0.03 and 0.03 for Groups A-C compared to D, respectively. CONCLUSION: POE can be best prevented by prophylactic moxifloxacin by presoaked IOLs treatment.

Penetration of moxifloxacin through crosslinked corneas.

PURPOSE: To determine the ability of moxifloxacin to penetrate the rabbit eye after corneal collagen crosslinking (CXL) with riboflavin and ultraviolet-A light irradiation. SETTING: Harlan Biotech Israel, Rehovot, Israel. DESIGN: Experimental study. METHODS: One eye of 10 New Zealand white rabbits had CXL treatment. One month after treatment and 1 hour before an aqueous humor sample was obtained, 1 drop of 5 mg/mL moxifloxacin (Vigamox) was applied to both eyes of each rabbit every 15 minutes for a total of 4 drops. The aqueous humor samples were sent for high-performance liquid chromatography for antibiotic-concentration analysis. The eyes were enucleated and sent for histology analysis. RESULTS: Moxifloxacin levels were obtained and analyzed for all 20 eyes. The mean level of moxifloxacin was 2.26 µg/mL ± 0.89 (SD) (range 1.09 to 4.20 µg/mL) in the treated eyes and 2.43 ± 1.17 µg/mL (range 0.89 to 4.72 µg/mL) in the untreated eyes. The difference between the groups was not statistically significant. Of the 10 eye pairs, lower moxifloxacin aqueous humor concentrations were found in 6 treated eyes and 4 untreated eyes. CONCLUSION: Penetration of moxifloxacin into the anterior chamber of rabbits was not influenced by previous CXL treatment. FINANCIAL DISCLOSURES: No author has a financial or proprietary interest in any material or method mentioned.

Intraocular concentration of moxifloxacin after intracameral injection combined with presoaked intraocular lenses.

PURPOSE: To evaluate the impact of intraocular lens (IOL) moxifloxacin presoaking time on the intraocular concentration of moxifloxacin achieved after intracameral moxifloxacin injection. SETTING: Harlan Biotech Israel, Rehovot, Israel. DESIGN: Laboratory study METHODS: Sixty eyes of 30 rabbits were divided into 2 groups after crystalline lens evacuation. In Group A (30 eyes), hydrophilic acrylic IOLs presoaked for 15 minutes in 5 mg/mL moxifloxacin were implanted. In Group B (30 eyes), the same hydrophilic acrylic IOLs presoaked in the same solution for 24 hours were implanted. Intracameral injection of 100 mcg/0.1 moxifloxacin was performed at the end of surgery in both groups. Aqueous humor samples were obtained 2, 4, 6, 8, and 10 hours after IOL implantation and were analyzed by high-performance liquid chromatography to determine the antibiotic concentration. RESULTS: Group A achieved mean postoperative moxifloxacin concentrations of 18.60 mcg/mL±8.80 (SD), 4.08±6.03 mcg/mL, 1.50±0.75 mcg/mL, 0.21±0.09 mcg/mL, and 0.12±0.04 mcg/mL at 2, 4, 6, 8, and 10 hours, respectively. Group B achieved mean moxifloxacin concentrations of 17.25±6.27 mcg/mL, 9.46±2.22 mcg/mL, 6.26±1.22 mcg/mL, 4.34±0.42 mcg/mL, and 3.62±1.02 mcg/mL, respectively. Moxifloxacin concentrations at 6, 8, and 10 hours were statistically significantly higher in Group B than in Group A (all P<.0001). CONCLUSIONS: Combining intracameral moxifloxacin injection with implantation of moxifloxacin-presoaked hydrophilic acrylic IOLs yielded high intraocular concentrations of moxifloxacin. Higher concentrations were found with longer presoaking. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Hydrophilic acrylic intraocular lens as a drug delivery system: influence of the presoaking time and comparison to intracameral injection.

PURPOSE: To evaluate the influence of different intraocular lens (IOL) presoaking times in an antibiotic solution and to compare the results with intracameral antibiotic injection alone. METHODS: Part A: 45 IOLs were soaked in gatifloxacin, moxifloxacin, or prednisolone acetate for 10 min, 24 h, and 1 week and then placed in a vial with a balanced salt solution. The solutions were sampled 12 and 24 h later. Part B: 90 eyes of 45 rabbits were divided into three groups. Group A received intracameral injection of moxifloxacin after lens removal and nonpresoaked IOL implantation. Groups B and C were implanted with IOLs that were presoaked for 15 min in moxifloxacin (group B) or gatifloxacin (group C), after lens removal with no intracameral antibiotic injections. Aqueous humor samples were taken 2, 4, 6, 8, and 10 h after surgery for high-performance liquid chromatography. RESULTS: Part A: In comparison with the 24-h group, the 10-min group showed release of about 30% of the antibiotics amount; the 1-week group showed a longer release time of the antibiotics and an increase of 27% for gatifloxacin and 43% for moxifloxacin. No prednisolone acetate was found. Part B: The moxifloxacin concentrations in the intracameral injection group were higher after surgery, but with faster antibiotic decrease in comparison with both presoaked IOL groups. CONCLUSION: Intracameral antibiotic injection showed a high antibiotic concentration for a short time. Presoaked IOLs showed slower decrease rates of the antibiotic level.

Safety assessment of a new single-use small-incision injector for intraocular lens implantation.

PURPOSE: To evaluate the safety of a new injector, the Raysert R-INJ-04/18, for implantation of the C-flex intraocular lens (IOL). SETTING: Ophthalmology Department, Kaplan Medical Center, Rehovot, Israel. DESIGN: Experimental study. METHODS: Sixty IOLs were subdivided into 2 equally sized groups. Group A IOLs were injected using the established R-INJ-04 injector, and those in Group B were injected with the new injector. The IOLs were injected into a Petri dish. Subsequently, all IOLs and injectors were evaluated macroscopically and microscopically and then photographed under light microscopy (LM). Two IOLs in each group were randomly chosen and sent for evaluation by scanning electron microscopy (SEM) and energy dispersive analysis of x-ray. All remaining IOLs were sent for power and modulation transfer function (MTF) analysis. RESULTS: All Group B IOLs were successfully injected without evident signs of scratching, cracks, or deposits on LM and SEM examination. In Group A, findings were confined to a singular incidence of a small deposit detected on the periphery of the posterior optical surface of the IOL, with corresponding findings detected on the injector nozzle. No signs of scratching, cracks, or deposits were found in the rest of the IOLs or injectors. The power and MTF analyses were within the normal range for all IOLs. CONCLUSION: The new 1.8 mm external diameter soft-tipped injector for 2.4 to 2.2 mm incisions was shown to be safe for the implantation of the C-flex 21.0 diopter IOL.

Protective effect of different ophthalmic viscosurgical devices on corneal endothelium during severe phacoemulsification model in rabbits.

BACKGROUND AND OBJECTIVE: To evaluate the protective effect of different ophthalmic viscosurgical devices (OVDs) on corneal endothelial cells against relatively severe phacoemulsification damage in a rabbit model. MATERIALS AND METHODS: Twenty-four rabbit eyes were randomly assigned to four similar groups: in three groups the aqueous humor was completely replaced by Visiol (TRB CHEMEDICA, München, Germany), Biolon (Bio-Technology General Ltd., Kiryat Malachi, Israel), and Viscoat (Alcon, Puurs, Belgium) and in the control group no OVD was applied. Endothelial cell counts were performed prior to initiating the study. All eyes were exposed to continuous 5 minutes of phacoemulsification. Endothelial cell counts were repeated 4 days postoperatively. RESULTS: Viscoat showed the highest endothelial cell loss (30%), followed by Biolon (25%), Visiol (22%), and the control group (19%). None of the differences between the groups were found to be statistically significant, although they were within each group (P = .028). CONCLUSION: None of the tested OVDs demonstrated protective effect on corneal endothelial cells in comparison to the control group. This model was found to be too aggressive for the demonstration of the protective effect of different OVDs even for hard cataract.

Protective effect of different ophthalmic viscosurgical devices on corneal endothelial cells during phacoemulsification: rabbit model.

PURPOSE: To evaluate the protective effect of different ophthalmic viscosurgical devices on corneal endothelial cells during phacoemulsification in a rabbit model. SETTING: Harlan Biotech Israel and Ophthalmology Department, Kaplan Medical Center, Rehovot, Israel. DESIGN: Experimental study. METHODS: Rabbit eyes were randomly assigned to 3 equally sized groups. Endothelial cell counts were performed in all eyes before initiation of the study. The aqueous humor was completely replaced by Biolon (sodium hyaluronate 1.0%) in Group A, by a combination of Viscoat (sodium chondroitin sulfate 4.0%-sodium hyaluronate 3.0%) and Provisc (sodium chondroitin sulfate 1.0%) using the soft-shell technique in Group B, and by a combination of Visiol (sodium hyaluronate 2.0%-mannitol 0.5%) and Biolon using the soft-shell technique in Group C. The eyes were exposed to alternating 10 seconds of phacoemulsification and a 10-second pause until a total exposure time of 2.5 minutes elapsed. Endothelial cell counts were repeated 3 days after surgery. RESULTS: The study used 18 rabbit eyes, 6 in each group. Group A had the highest endothelial cell loss (13%) followed by Group B (7%), and Group C (4%). The difference in cell loss between Group C and Group A was statistically significant (P = .037). CONCLUSION: The study showed the efficiency and advantages of the soft-shell technique using the combination of Visiol and Biolon over Biolon alone.