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T. Uda, Y. Tasaka, S. Kawasaki, T. Mito, T. Suzuki, T. Uno, Y. Ike, Y. Ohashi; The Evaluation of Intracameral Injection of Levofloxacin in the Prophylaxis of Postoperative Enterococcus Faecalis Endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2902.
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Rupture of the lens capsule is known to be a risk factor for endophthalmitis and suppurative posterior infection. Intracameral injection of antibiotics should be one of option for prevention of endophthalmitis in high risk cases having rupture of the lens capsule. This study was designed to evaluate intracameral injection of levofloxacin (LVFX) for prophylaxis of endophthalmitis using an aphakic rabbit model.
After the lens removal by phacoemulsification with intentional rupture of lens capsule, LVFX (500µg/0.1ml) was injected into anterior chamber. The eyes were enucleated 2 hour after injection, and the concentration of LVFX in vitreous humor and aqueous humor was estimated using high performance liquid chromatography. To determine the efficacy of LVFX intracameral injection for prevention of endophthalmitis, aphakic eyes inoculated with 1×104colony-forming units (CFU) of E. faecalis OG1S (secreted protease-positive) into anterior chamber having rupture of lens capsule were used. After bacterial inoculation, intracameral injection of LVFX (500µg/0.1ml) or saline was performed. Changes in electroretinography (ERG) and numbers of organisms were determined and compared throughout the infection by 48 hour.
Mean ± SD concentrations of LVFX 2 hour after intracameral injection were as follows: aqueous humor (129±53 µg/ml) and vitreous humor (anterior part; 45.2±29.8µg/ml, mid part; 63±63.9µg/ml, posterior part; 74.8±80.8µg/ml). Eyes treated with saline resulted in a significantly greater reduction of B-wave amplitude of ERG at 48 hour than eyes treated with LVFX. (test/control eye ratio; saline:12.4±7.9 %, LVFX: 124.3±29.8 %; P<0.01) The number of bacteria recovered from vitreous humor in the eye treated with LVFX at 48 hour was significantly less than eyes treated with saline. (saline: 8.2±0.6 log10 CFU/tissue, LVFX: 5.1±1.3 log10 CFU/tissue, P<0.01)
Intracameral injection of LVFX into eyes with rupture of lens capsule can penetrate deeply and was effective in preventing endophthalmitis caused by E. faecalis.
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