Transcript ASCRS Comparison of the effects of fourth

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
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
• Grepafloxacin
• Levofloxacin
• Ciprofloxacin
• Lomefloxacin
• Norfloxacin
• Ofloxacin
• Gatifloxacin
Introduction
Broad spectrum of
activity
Good ocular
penetration
- more susceptible of
gram-positive orginism
- Improved penetration
into ant. chamber
- Atypical mycobacteria
coverage
4th generation
fluoroquinolones
advantage
Better MIC90
Less resistance
BUT, may inhibit corneal wound healing
(minimum inhibitory
concentration 90s)
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.
Purpose
To compare the effects on epithelial healing of gatifloxacin and
moxifloxacin used for antimicrobial prophylaxis following
photorefractive keratectomy (PRK)
Preservative-free
Preservative-free
Subjects and methods
Design
Double-masked
randomized
prospective trial
Subject
Forty-four patients undergoing
PRK(photorefractive keratectomy)
with 7mm epithelial defect
Method
Received gatifloxacin(Gatiflo® 0.3%, no preservative) in one eye and
moxifloxacin(Vigamox® 0.5%, no preservative) in fellow eye
for prophylactic antibiotics
Outcome
Mean epithelial healing time
Mean defect size
Pain score
MEL80
Subjects and methods
POD #1
POD #2
POD #3
Ex.
OD
Gatiflo®
28164 pixels
4371 pixels
0 pixels
25793 pixels
2017 pixels
0 pixels
OS
Vigamox
®
 Data analysis
 Mann-Whitney U test
 SPSS 12.0 (SPSS Inc., USA)
 p value < 0.05
Defect
calculation
(pixels)
:using Adobe
photoshop CS3
Results
Results
[Table 1] The mean epithelial healing time and mean defect size
Gatiflo®
Vigamox®
P-value†
2.97±0.41
2.95±0.48
0.810
POD#1
43200.2±11475.8
40303.6±11211.6
0.327
POD#2
6959.4±8325.3
5988.1±7616.3
0.578
POD#3
205.9±1026.7
333.1±1265.2
0.606
Healing time(d)
Mean defect
size(pixels)
† Mann-whitney U test
POD: postoperative day
No significant difference
in the effects of fourth-generation fluoroquinolones
Results
[Table 2] Vision(VA & BCVA) of POD #90 and pain score
Gatiflo®
Vigamox®
P-value†
VA(logMAR)
-0.036±0.081
-0.064±0.051
0.562
BCVA(logMAR)
-0.091±0.054
-0.082±0.060
0.748
POD#1
2.64±0.78
2.95±0.69
0.438
POD#2
1.73±0.90
1.73±0.90
1.000
POD#3
0.45±0.52
0.68±0.56
0.401
Pain score(0~4)
† Mann-whitney U test
VA : visual acuity, BCVA : best corrective visual acuity
No significant difference
in the effects of fourth-generation fluoroquinolones
Pain score(0~4)
0
1
2
3
4
no pain
mild
discomforting(burning sense)
distressing(need analgesic)
excruciating(not subside
despite analgesic)
Discussion
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.
This result carries an important meaning
because both eye drops we used are
preservative-free.
ASCRS
Thank you for your attention