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M.N. Iyer, F. He, T.G. Wensel, W.F. Mieler, M.S. Benz, E.R. Holz; Clearance of Intravitreal Moxifloxacin . Invest. Ophthalmol. Vis. Sci. 2005;46(13):3535.
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Purpose: Moxifloxacin is a new generation fluoroquinolone with superior broad spectrum coverage against the organisms typically encountered in bacterial endophthalmitis. The purpose of this study was to determine the clearance of a single dose of intravitreally injected moxifloxacin in rabbits, and thereby to determine the clinical relevance of intravitreal moxifloxacin in the management of bacterial endophthalmitis. Methods: Institutional Review Board approval for this study was obtained. Intravitreal injections of 200 micrograms/0.1 ml of moxifloxacin were performed in pigmented Dutch Belted rabbits to achieve a total vitreal concentration of approximately 150 micrograms/ml. Four eyes per time interval after injection (1 hour, 6 hrs, 12 hrs, 24 hrs, 36 hrs, and 48 hrs) were enucleated and immediately frozen and placed at –80 C. Ocular dissection and isolation of frozen vitreous was performed. Aqueous samples were also acquired at the various time intervals after injections. Antibiotic assays were performed using high performance liquid chromatography. Results: The clearance of intravitreal moxifloxacin showed an exponential decay with a half–life of 1.72 hours. Drug levels in the vitreous were undetectable after 12 hours of injection. The aqueous levels of moxifloxacin also showed an exponential decay from 10 mcg/ml at 1–hour post–intravitreal injection to undetectable levels by 12–hours post–injection. Conclusions: Moxifloxacin clearance from the vitreous is rapid and consistent with previous clearance studies on Ciprofloxacin. Given that the injected dose corresponds to 72–to–3500 times the MIC–90 of organisms commonly involved in endophthalmitis, and that therapeutic levels are present for approximately 6–to– 8 hours, intravitreal moxifloxacin may have a role in the treatment of endophthalmitis.
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