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L. M. Nijm, E. Y. Tu, L. J. Ulanski, II, R. Fiscella, Jr., R. Peterson, L. T. Davis, R. D. Glickman; The Future of Endophthalmitis Prophylaxis? Intraocular Drug Delivery of Gatifloxacin via a Hydrophilic IOL. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5536. doi: https://doi.org/.
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To determine whether implanting a STAAR Collamer hydrophilic intraocular lens, soaked in gatifloxacin 0.3% would result in release of sufficient antibiotic to effectively inhibit the most common pathogens that cause endophthalmitis.
STAAR Collamer IOLs were immersed in commercially available gatifloxacin 0.5% for various time intervals and implanted in the capsular bag of 11 rabbit eyes after evacuation of the crystalline lens. Controls were performed by injecting 0.1 mL of intracameal gatilfoxacin into 6 additional rabbit eyes after evacuation of the crystalline lens and implantation of a standard STAAR IOL. Aqueous humor samples were taken at 30 minutes, 2 hours, 4 hours, 6 hours, and at 24 hours aqueous and vitreous samples were taken and assessed using HPLC. Pathology was performed on a sample of rabbit eyes post-mortem.
The average peak aqueous concentration of gatifloxacin from the soaked IOLs was 37.9 µg/mL ± 22.7µg/mL at 1.12 hours. At 24 hours, the average aqueous concentration of gatifloxacin soaked IOLs was 1.58 µg/mL ± 1.75. Finally, at 24 hours, the vitreous concentration in gatifloxacin soaked IOLs was 0.66 µg/mL ± 0.41. The average initial concentration of gatilfoxacin in the intracameral controls was greater than that of the soaked IOLs, however, the rate of decay was also much more rapid. Also, no significant levels of gatifloxacin was detected at 24 hours. The overall rate of decay of the gatilfoxacin soaked IOLs was similar to that demonstrated by moxifloxacin soaked IOLs in our previous study. No signs of toxicity were noted on pathology of the specimens.
• Implanting a STAAR hydrophilic IOL, soaked in gatifloxacin, resulted in sustained release of antibiotic at levels which greatly exceeded the MIC90 for most of the common pathogens that cause endophthalmitis.• Moreover, gatifloxacin was released at theoretically safer, sustained, therapeutic levels, avoiding the excessive initial concentrations seen with most intracameral antibiotic administration.• Concentrations of antibiotic in the aqueous humor in gatifloxacin soaked IOLs were lower than those in our previous moxifloxacin soaked IOLs study, however, this seemed to correlate with relative soak times and starting concentrations of each respective antibiotic.• This research demonstrates that at least one type of hydrophilic IOL may be utilized as a drug delivery system for the prevention of endophthalmitis.
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