ASCRS Comparison of the effects of fourth-generation fluoroquinolones on epithelial healing after PRK

1. Neither of authors has a financial or proprietary interest in any material or method mentioned. ASCRS Comparison of the effects of fourth-generation fluoroquinolones on epithelial healing after PRK Department of Ophthalmology College of Hallym University Hallym Medical Center Seoul, South Korea Jung Hwan Shin MD Ha Bum Lee MD Hye Young Park MD

2. Introduction Fluoroquinolones, with excellent broad-spectrum coverage and good ocular tolerance, have been frequently used as prophylactic agents both for traumatic corneal erosions and in refractive surgery. Fourth Generation Third Generation Second Generation • Moxifloxacin • Gatifloxacin • Grepafloxacin • Levofloxacin • Ciprofloxacin • Lomefloxacin • Norfloxacin • Ofloxacin

3. Introduction • Good ocular penetration • Improved penetration • into ant. chamber • Broad spectrum of activity • - more susceptible of • gram-positive orginism • Atypical mycobacteria • coverage 4th generation fluoroquinolones advantage Better MIC90 (minimum inhibitory concentration 90s) Less resistance BUT, may inhibit corneal wound healing

4. Introduction One study showed Comparison of Zymar and Vigamox on clinical setting(post PRK)  Their study suggests that Vigamox has a more favorable epithelial healing profile in a post PRK But, because of Zymar is contained BAK, it is not a same condition.

5. Purpose To compare the effects on epithelial healing of gatifloxacin and moxifloxacin used for antimicrobial prophylaxis following photorefractive keratectomy (PRK) Preservative-free Preservative-free

6. Double-masked randomized prospective trial Design Forty-four patients undergoing PRK(photorefractive keratectomy) with 7mm epithelial defect Subject Received gatifloxacin(Gatiflo® 0.3%, no preservative) in one eye and moxifloxacin(Vigamox® 0.5%, no preservative) in fellow eye for prophylactic antibiotics Method Subjects and methods MEL80 Mean epithelial healing time Mean defect size Pain score Outcome

7. Subjects and methods Ex. POD #2 POD #3 POD #1 Defect calculation (pixels) :using Adobe photoshop CS3 OD Gatiflo® 28164 pixels 4371 pixels 0 pixels OS Vigamox® 2017 pixels 0 pixels 25793 pixels • Data analysis • Mann-Whitney U test • SPSS 12.0 (SPSS Inc., USA) • p value < 0.05

8. Results

9. Results [Table 1] The mean epithelial healing time and mean defect size No significant difference in the effects of fourth-generation fluoroquinolones

10. Results [Table 2] Vision(VA & BCVA) of POD #90 and pain score Pain score(0~4) 0 no pain         1     mild             2     discomforting(burning sense)   3     distressing(need analgesic)     4     excruciating(not subside despite analgesic) No significant difference in the effects of fourth-generation fluoroquinolones

11. Discussion This result carries an important meaning because both eye drops we used are preservative-free. This study demonstrated that the commercial ophthalmic formulations of moxifloxacin(Vigamox®) and gatifloxacin(Gatiflo®) were similar to each other in their effects on rates of corneal wound re-epithelialization.

12. ASCRS Thank you for your attention