Effects%20of%20Intracameral%20Moxifloxacin,%20Levofloxacin,%20and%20Cefazolin%20on%20Corneal%20Endothelial%20Cells%20in%20Rabbits

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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,

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Prevention of endophthalmitis
Introduction

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

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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

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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 .

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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)

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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

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Purpose

• To compare the effect on corneal endothelial cell
  among intracameral moxifloxacin, levofloxacin,
  and cefazoline in Rabbits

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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.

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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)

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Cefazolin Levofloxacin Moxifloxacin
1ST generation cephalosporine 3rd generation quinolone 4th generation quinolone
Inhibiting bacterial cell wall synthesis Only DNA gyrase for G- Only topoisomerase IV for G Both bacterial DNA gyrase (topoisomerase II), topoisomerase IV ? dual action ? efficacy ?
More effective against G bacteria than G-Bacteria Most aerobic G -, Some G bacteria G , G - Resistant G , Nontuberculous Mycobacteria, Nocardia
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Concentration(ug/0.1cc) Osmolarity (Osm/l) pH
Cefazolin 1,000 322-324 5.8
Levofloxacin 500 300 6.2- 6.8
Moxifloxacin 500 290 6.8
humans 200 - 400 6.5 - 8.5
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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
(p0.33).
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Central corneal thickness after the injection
corneal thickness (um SD)
There was no significant difference in corneal
thickness after the injection among four groups
(p0.12).
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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 (p0.24).
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The mean endothelial cell count one day after
intracameral injection
Mean endothelial cell count (cells/mm2SD)
No statistically significant difference was noted
among four groups (p0.248).
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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 (p0.248).
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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.
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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
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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.

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Thank You
For Your Attention!