Short term oral minocycline treatment of meibomianitis.

AIM: To evaluate the clinical impact, aqueous tear parameters, and meibomian gland morphology in patients with primary meibomianitis before, during, and 3 months after a course of oral minocycline. METHODS: 16 patients were prospectively enrolled, 11 male and five female (mean age 69 years old). Each patient received routine clinical evaluations before, after 3 months therapy, and at 6 month study follow up visit. The clinical appearance, tear volume, flow and turnover, evaporation, Schirmer I test, meibomian gland dropout, lissamine green staining, and bacteriology wer evaluated. RESULTS: Improvement was observed in clinical signs of meibomianitis at the second and third visits. Microbial culture findings improved. Decreased aqueous tear volume and flow, and increased evaporation rate range at 35-45% relative humidity (RH) (p < 0.05) were also detected. Other related tear parameters did not change. Meibomian gland dropout showed no improvement. CONCLUSIONS: 3 months of oral minocycline resulted in clinical improvements in all meibomianitis signs that persisted for at least 3 months after discontinuation despite decreased aqueous tear volume and flow with increased evaporation (35-45% RH). However, there was improvement in the turbidity of secretions. Short term minocycline therapy probably has efficacy in the management of meibomianitis that extends beyond eradication of bacteria.

Fourth-generation fluoroquinolone penetration into the aqueous humor in humans.

PURPOSE: To compare the penetration and levels of the fourth-generation fluoroquinolones moxifloxacin 0.5% ophthalmic solution and gatifloxacin 0.3% solution in the aqueous humor (AH) in humans after topical application with published levels of other available fluoroquinolones under similar dosing conditions. DESIGN: Prospective, randomized, double-masked clinical trial. PARTICIPANTS: Forty-six patients undergoing cataract extraction. METHODS: Patients scheduled for routine phacoemulsification and intraocular lens implantation were provided either moxifloxacin 0.5% ophthalmic solution (n = 22) or gatifloxacin 0.3% ophthalmic solution (n = 24) to use 4 times daily the day before surgery plus 1 drop 1 hour before the surgical entry into the anterior chamber on the day of surgery. This regimen simulated a realistic postoperative dosing schedule. Aqueous humor samples were obtained and analyzed by high-pressure liquid chromatography. Aqueous humor fluoroquinolone concentrations were calculated by peak comparison with a known concentration peak for ciprofloxacin that was used as an internal standard. These values were compared with published concentrations of other available fluoroquinolones under similar dosing conditions. RESULTS: The mean age of the moxifloxacin 0.5% group was 67.8+/-9.7 years, whereas that of the gatifloxacin 0.3% group was 69.9+/-8.7 years. The moxifloxacin AH concentration was 1.86+/-1.06 microg/ml, and that of gatifloxacin was 0.94+/-0.72 microg/ml. This 2-fold difference was statistically significant (P = 0.001). CONCLUSIONS: Aqueous humor antibiotic concentrations achieved at the time of cataract surgery after topical application can serve as an effective surrogate for what can be achieved with typical postoperative topical dosing (e.g., 4 times daily). Both fourth-generation fluoroquinolones achieved a greater AH concentration after 4 times daily dosing relative to prior-generation fluoroquinolones. Moxifloxacin 0.5% ophthalmic solution achieved a 2-fold higher aqueous humor concentration than gatifloxacin 0.3% ophthalmic solution. The superior penetration of moxifloxacin into the AH may be attributed partially to its high degree of lipophilicity, greater solubility at neutral pH, and higher concentration in the commercial formulation. The enhanced penetration of moxifloxacin 0.5% ophthalmic solution may provide better protection against ocular infections.