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D.H. Kim, W.J. Stark, J.D. Dick, T.P. O'Brien; Comparative Ocular Penetration of Perioperative Topically Administered Fourth Generation Fluoroquinolones With Cataract Surgery . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4890.
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Purpose: To examine the ocular penetration of the new fluoroquinolones moxifloxacin 0.5% ophthalmic solution (VigamoxTM, Alcon Laboratories, Inc.) and gatifloxacin 0.3% solution (ZymarTM, Allergan, Inc.) into the aqueous humor following topical administration prior to routine cataract surgery. Methods: This study was a prospective, randomized, double masked, clinical trial of 50 patients undergoing cataract extraction, 25 patients were given perioperative topical moxifloxacin 0.5% and 25 patients were given topical gatifloxacin 0.3%. Patients were administered one drop of antibiotic every ten minutes for four doses beginning one hour before surgery. Patients also received preoperative dilating drops, phenylephrine 2.5%, cyclopentolate 1%, and tropicamide every ten minutes for four doses. At the time of surgery, topical proparicane drops and lidocaine gel was administered and the eye was prepped with 5% providone iodine and draped using sterile technique. A 15–degree superblade was used to make a paracentesis, and then a 30–gauge cannula on a tuberculin syringe was used to acquire the aqueous specimen. The sample of aqueous humor was collected at the time of incision with a one–hour window from the time of the last antibiotic drop and stored at –70º C. Aqueous humor antibiotic concentrations were determined using validated high performance liquid chromatography (HPLC) procedures. Results: Aqueous humor concentrations for moxifloxacin that were 1.80 (± 1.21) µg/ml while those for gatifloxacin were 0.48 (± 0.34) µg/ml. This 3.8–fold difference in antibiotic concentrations was statistically significant (P = 0.00003). Conclusions: This study showed that following topically administered perioperative antibiotics with cataract surgery, moxifloxacin 0.5% ophthalmic solution had a statistically significant 3.8–fold higher concentration over gatifloxacin 0.3% in the aqueous humor.
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