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R. P. Kowalski, E. G. Romanowski, F. S. Mah, K. A. Yates, Y. J. Gordon; Topical Moxifloxacin Prevents Endophthalmitis After Triamcinolone Intravitreal Injection in a Rabbit Model. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2674.
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Frequent intravitreal injections of triamcinolone for the treatment of macular disease has increased the chance of endophthalmitis. In this in vivo study, we investigated the potential of topical moxifloxacin (Vigamox) to prevent endophthalmitis after an intravitreal injection of triamcinolone.
A rabbit model of intravitreal injection was developed by injecting triamcinolone into the vitreal cavity through a depot of subconjunctival Staphylococcus aureus (107 colony forming units) that was deposited 1 hour earlier. Endophthalmitis was determined by typical clinical presentations and confirmation by a positive bacterial culture from the vitreous. The model was tested with two topical treatment groups: 1) 10 Vigamox and 2) 10 saline. In brief, after S. aureus subconjunctival challenge, topical treatment was administered every 15 minutes for 1 hour (5 drops) immediately before an intravitreal injection of triamcinolone (4 mg/0.1 ml) through the treated bacterial depot. Topical Vigamox or saline was administered QID over the next 72 hours. All rabbits were examined daily, sacrificed, and tested for viable bacteria when clinical signs of endophthalmitis were observed. Remaining animals were sacrificed and tested for viable bacteria at 72 hours.
Antibiotic treatment with topical Vigamox (0/9) prevented the development of endophthalmitis in comparison with topical saline (6/10) (Fisher’s exact, p=0.01). The Vigamox treated eyes were culture-negative compared to the median colony count of 1.55 x 105 cfu/ml for the saline treated. (Mann-Whitney, p=0.02) The total clinical scores for the saline treated eyes (17.17) were significantly higher than the Vigamox treated (1.28). (p=0.0001, ANOVA)
Topical Vigamox prevented endophthalmitis after an intravitreal injection of triamcinolone. The clinical implication is that Vigamox may prevent endophthalmitis after intravitreal injection by eliminating the bacteria flora at the injection site. Additional clinical studies are needed to support this implication.
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