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Effects of Intracameral Moxifloxacin, Levofloxacin, and Cefazolin on Corneal Endothelial Cells in Rabbits

Effects of Intracameral Moxifloxacin, Levofloxacin, and Cefazolin on Corneal Endothelial Cells in Rabbits. Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea. Su-Young Kim, . Introduction. Prevention of endophthalmitis.

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Effects of Intracameral Moxifloxacin, Levofloxacin, and Cefazolin on Corneal Endothelial Cells in Rabbits

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  1. Effects of Intracameral Moxifloxacin, Levofloxacin, and Cefazolin on Corneal Endothelial Cells in Rabbits Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea Su-Young Kim,

  2. Introduction Prevention of endophthalmitis • Antiseptics on the ocular surface • Topical antibiotics preoperatively and postoperatively • Recently, intracameral injection of antibiotics has been raised to decrease incidence of postoperative endophthalmitis.

  3. Intracameral antibiotics (cataract surgery) • Intracameral cefazolin as prophylaxis against endophthalmitis in cataract surgery (J Cataract Refract Surg 2006) “ Intracameral bolus injection of cefazolin(1mg in 0.1mL solution) in cataract surgery demonstrated prophylactic efficacy in diminishing the rate of postoperative endophthalmitis without toxic effects on the cornea or retina”

  4. Intracameral antibiotics (cataract surgery) • Safety of prophylactic intracameral moxifloxacin 0.5% ophthalmic solution in cataract surgery patients (J Cataract Refract Surg 2007) “ Intracameral Vigamox 0.5mg/mL appeared to be nontoxic in terms of visual rehabilitation, anterior chamber reaction, pachymetry and corneal endothelial cell density .”

  5. Intracameral antibiotics (cataract surgery) • Prophylactic intracameral vancomycin (J Cataract Refract Surg 2004) • Prophylactic intracameral cefuroxime; efficacy in preventing endophthalmitis after cataract surgery (J Cataract Refract Surg 2002)

  6. Intracameral antibiotics • Effective and safe as surgical prophylaxis • Intracameral vancomycin is not preferred as the general prophylaxis in cataract surgery because of the opinion that vancomycin should be reserved for last antibiotics due to its powerful potency • Vancomycin can induce cystoid macular edema

  7. Purpose • To compare the effect on corneal endothelial cell among intracameralmoxifloxacin, levofloxacin, and cefazoline in Rabbits

  8. Materials and Methods • Thirty six eyes from eighteen New Zealand rabbits • Pre-injection central corneal thickness • After removal of aqueous humor 0.1ml using 30 gauge needle • intracameral injection of BSS 0.1ml (always the other eye) • cefazolin 1000µg/0.1ml diluted with saline 0.9% • levofloxacin (0.5%, Cravit®, Santen, Japan) 500µg/0.1ml • moxifloxacin (0.5%, Vigamox®, Alcon, USA) 500µg/0.1ml • Cefazolin, Cravit®, and Vigamox® contain no preservatives.

  9. Materials and Methods • One day after intracameral injection • central corneal thickness cornea with a 2.0-mm rim of sclera was excised • specular microscopy (KeratoAnalyzer (EKA-04), Konan medical Inc., Japan ) • scanning electron microscopy (SEM) • transmission electron microscopy (TEM)

  10. Results Central corneal thickness before the injection corneal thickness (um ± SD) There was no significant difference in corneal thickness before the injection among four groups (p=0.33).

  11. Central corneal thickness after the injection corneal thickness (um ± SD) There was no significant difference in corneal thickness after the injection among four groups (p=0.12).

  12. The mean change between pre-injection value and post-injection value of central corneal thickness Change of corneal thickness (um ± SD) The mean change between pre-injection value and after-injection value was not significantly different among four groups (p=0.24).

  13. The mean endothelial cell count one day after intracameral injection Mean endothelial cell count (cells/mm2±SD) No statistically significant difference was noted among four groups (p=0.248).

  14. BSS Cefa Levo Moxi Fig . Specular microscopy 1 day after intracameral injection. The endothelium cell counts in all four groups was normal with no statistically significant difference among four groups (p=0.248).

  15. BSS Cefa Levo Moxi Fig . SEM 1 day after intracameral injection. The endothelium in all four groups was regular in appearance, and had normal mosaic-like cellular pattern. Original magnification ×1,000.

  16. BSS Cefa Levo Moxi Fig . TEM 1 day after intracameral injection. The endothelium in all four groups was normal height and normal intercellular space. Original magnification ×2,500-6,000

  17. Conclusion • Intracameral injection of antibiotics (cefazolin 1000ug/0.1cc, levofloxain 500ug/0.1cc, Moxifloxacin 500ug/0.1cc) did not show significant toxicity on endothelial cell compared with the control group. • Intracameral injection of one of these antibiotics will be safe for surgical prophylaxis. • When we consider risk-benefit or cost-effectiveness, intracameral injection can be especially useful to high-risk patients with trauma, diabetics, chronic blepharitis, intraoperative contamination.

  18. Thank You For Your Attention!

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