A Comparison of the Effectiveness of Soaking Acrylic Hydrophilic and Acrylic Hydrophobic Intraocular Lenses in Moxifloxacin 0.5%

Abstract

Purpose: : To determine the levels of moxifloxacin achieved in an artificial anterior chamber by soaking the hydrophobic acrylic AcrySof® SA60 (Alcon Inc.) IOL and the hydrophilic collamer Afinity^TM CQ2015 (Staar) IOL in commercially available moxifloxacin 0.5% (Vigamox®, Alcon Inc.). The lenses were soaked for either 1 minute or 10 minutes.

Methods: : 40 IOLs (20 SA60 and 20 CQ2015) were soaked in 1 cc of commercially available moxifloxacin 0.5%. Ten of each for 1 minute, and ten of each for 10 minutes. The IOLs were patted dry with absorbent pads (BD Biosciences) and placed in vials of 10 cc Balanced Salt Solution (BSS) for 30 minutes. 5 cc of the BSS were removed and analyzed by High Pressure Liquid Chromatography (HPLC) to determine the antibiotic levels achieved.

Results: : The moxifloxacin levels achieved after soaking the CQ2015 lens were 0.283 µg/ml and 0.717 µg/ml for 1 and 10 minute soaks, respectively. The moxifloxacin levels achieved after soaking the SA60 lens were 0.238 µg/ml and 0.342 µg/ml for 1 and 10 minute soaks, respectively.

Conclusions: : The hydrophilic lens was a more efficient delivery system than the hydrophobic lens. Both lenses were capable of delivering clinically significant antibiotic levels after a 1 minute soak. Moxifloxacin concentrations reached at both one minute and ten minute soak times exceed the MIC90 of the most common pathogens responsible for post-operative endophthalmitis, Staphylococcus epidermidis (0.13 µg/ml), Staphylococcus aureus (0.06 µg/ml), and Haemophilus influenzae (0.06 µg/ml). Levels from the 10 minute soak of SA60 and both times for CQ2015 also exceeded the MIC90 for Streptococcus spp (0.25 µg/ml) and Proteus mirabilis (0.25 µg/ml). Current prophylaxis practice includes isolation of the eyelids and lashes, topical betadine, and pre- and post-operative topical antibiotics. The antibiotic-soaked IOL has potential to become a clinically significant technique in the prevention of postoperative endophthalmitis.

Keywords: intraocular lens • endophthalmitis • antibiotics/antifungals/antiparasitics