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A. Abbas; Sterilization of the Ocular Surface One and Three Hours After Clear Corneal Phaco–emulsification Surgery in Patients Using Fourth Generation Flouroquinolones . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5545.
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Purpose: Complete sterilization of (AF) occurs in patients receiving gatifloxacin or moxifloxacin pre–operatively. There seems to be an alarming association between endophthalmitis after phacoemulsification cataract extraction and IOL implantation (PCE–IOL ) and the increasing use of the temporal clear corneal approach. McDonnel et al showed that temporal clear corneal wound (CCW) architecture was unstable at lower intraocular pressures (IOP) with influx of external fluid into the wounds. This phenomenon might be linked to the recent increase in endophthalmitis incidence. This study is designed to compare the prophylactic antibacterial effectiveness of the two fourth generation (FQ) in sterilizing the external surface of the eye pre–operatively and at one and three hours post–operatively as this is probably the time period where transient reduction in IOP occurs with the possibility of influx of ocular surface fluid. Methods: Twenty consecutive patients undergoing routine PCE and IOL implantation surgery were randomized into two groups receiveing either moxifloxacin 0.5% or gatifloxacin 0.3% eye drops as pre–operative antibacterial prophylaxis in the following manner. QID one day pre–operatively and then, 1 drop four times (Q15 minutes) just before surgery. A swab culture of the inferior conjunctival fornix was obtained before surgical preparation and draping of the eye and instillation of 5% povidone iodine into the eye. After routine PCE–IOL using a temporal clear corneal approach the patient received one drop of timolol 0.5% solution, a drop of topical steroid suspension and a drop of the antibiotic solution and was patched with a sterile eye pad. One hour later, the dressing was removed and a culture was obtained from the inferior conjunctival fornix and then again at three hours. The post–operative drug schedule was initiated which included the antibiotic, a topical NSAID drop and a topical steroid drop QID. Results: Complete sterilization of the tear film occurred at all points in the study and no significant growth occurred for patients using either fourth generation flouroquinolone. Conclusions: This study showed that both Gatifloxacin and Moxifloxacin are equally effective in sterilizing the ocular surface and maintaining that status up to three hours after surgery. Along with the high AF levels reached by both antibiotics, this finding may provide an additional level of protection should there be an influx of ocular surface fluid into the anterior chamber.
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