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C. C. Murphy, S. Nichollson, S. A. Quah, M. Batterbury, T. Neal, S. B. Kaye; Pharmacokinetics of Vancomycin Following Intracameral Bolus Injection in Patients Undergoing Phacoemulsification Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1059.
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To determine the elimination kinetics of intracameral vancomycin administered as a bolus injection at the end of phacoemulsification cataract surgery.
Vancomycin 1mg/0.1ml saline solution was administered to 19 patients by intracameral bolus injection at the end of routine cataract surgery. The aqueous concentration of vancomycin was determined in 9 patients 1 minute after administration and in 10 patients approximately 20 hours post-operatively. Aqueous samples were obtained by inserting a Rycroft cannula into the anterior chamber via the side port incision. Fluorescence polarisation immunoassay was used to calculate the aqueous vancomycin concentration.
The median (interquartile range) vancomycin concentration was 5458 (4756 - 6389) mg/L and 40.6 (25.9 - 47.1) mg/L at 1 minute and 18 to 24 hours (median 19 hours) post-operatively, respectively. The vancomycin concentration exceeded the minimum inhibitory concentration of endophthalmitis-causing gram positive bacteria on average by a factor of between 8-10 twenty-four hours post-operatively. No adverse events or reactions were noted.
The concentration of vancomycin in the anterior chamber vastly exceeds therapeutic levels for at least 24 hours following bolus intracameral injection at the end of cataract surgery.
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