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L. M. Nijm, L. J. Ulanski, II, E. Y. Tu, R. Fiscella, Jr., R. Peterson; Using the STAAR Collamer Intraocular Lens as a Drug Delivery System for the Prevention of Endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2673.
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To examine the possibility of using a hydrophillic collamer intraocular lens as a drug delivery system for the prevention of endophthalmitis following cataract surgery.
Staar Surgical Collamer IOL's were immersed in moxifloxacin 0.5% (Vigamox), levofloxacin 0.5% (Quixin), and gatifloxacin 0.3% (Zymar) for 10 minutes and 15 minutes prior to being placed in a MAC (mock anterior chamber). The MAC consisted of an enclosed plastic chamber, 0.3ml in volume, attached to a micropump and a normal saline reservoir. Saline was pumped through the MAC at 5ul/min and the effluent passed through a spectrophotometer which measured the absorption a various wavelengths. The resultant absorption of MAC effluent was used to determine antibiotic concentrations over time. An in vivo model was also created, by implanting presoaked IOLs (soaked 15 minutes) in the capsular bag of 20 rabbits for a total of 40 eyes (12 eyes in each group, 4 eyes of control). Four rabbit eyes served as a control and had non-presoaked IOLs implanted. Aqueous humor samples were taken at 30 minutes, 2 hours, 4 hours, and 6 hours and measured using spectrophotometry as with the MAC effluent.
IOL's immersed in moxifloxacin for 15 minutes, prior to being placed in the MAC, developed a maximum MAC antibiotic concentration of 95ug/ml at 120 minutes, and concentrations greater than 4ug/ml were sustained for up to 10 hours. Immersion of IOL's in Moxifloxacin for 10 minutes resulted in a maximum MAC concentration of 57.5ug/ml and concentrations greater than 4ug/ml for up to 7 hours. Gatifloxacin and levofloxacin produced similar maximum concentrations and similar time dependent decays in antibiotic concentration. The in vivo model produced comparable therapeutic levels to the IOLs soaked in vitro for 15 minutes, but exhibited a decay curve reflective of a different volume of distribution and aqueous humor dynamics in vivo.
Immersion of a Collamer IOL in moxifloxacin, gatifloxacin, or levofloxacin prior to placement in a MAC produced therapeutic levels of antibiotic in the mock anterior chamber for up to 10 hours. Similarly, implantation of a Collamer IOL in a rabbit model produced therapeutic levels of antibiotics for up to 6 hours. Immersion of a hydrophillic collamer IOL in antibiotic, prior to insertion during cataract surgery, may be a viable option to help prevent endophthalmitis.
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