A Novel Multi-Observation System to Study the Effects of Anterior Ocular Inflammation in Zinn's Zonule Using One Specimen.

Zinn's zonule is a fragile and thin tissue, and little is known about its pathogenesis. The aim of this study was to develop an experimental setup for a comprehensive analysis of Zinn's zonule. Rats were divided into two groups: a control group (n = 4) and an alkali injury group (n = 4). Seven days after injury, the eyes were enucleated, the anterior eye was dissected and embedded in gelatin, and macroscopic observations were made. The gelatin specimens were then embedded in paraffin and observed in detail by low-vacuum scanning electron microscopy, immunofluorescence, and quantitative reverse transcription polymerase chain reaction (RT-qPCR). The results show qualitative changes in Zinn's zonules in both macroscopic and microscopic observations. In addition, macrophage infiltration and increased matrix metalloproteinase 2 (MMP2) expression were observed in the injured group, consistent with the RT-qPCR results. The experimental system in this study allowed us to capture the morphological and molecular biological changes of Zinn's zonule and to gain insight into its pathogenesis. In conclusion, this study presents a new experimental setup for the comprehensive analysis of the rat Zinn's zonule. The results suggest that this system can be used in the future to study and analyze a variety of paraffin-embedded tissues and specimens.

[Postcataract endophthalmitis caused by Enterococcus faecalis].

PURPOSE: Enterococcus faecalis is a major endophthalmitis-causing pathogen and often causes significant visual impairment. We investigated the clinical background, treatment and the visual outcome of patients with E. faecalis endophthalmitis after cataract surgery. METHODS: We retrospectively conducted a postal survey directed mainly at the members of Japanese Society of Cataract and Refractive Surgery, and collected data on 30 eyes of 30 patients with E. faecalis endophthalmitis. RESULTS: The mean age of the patients was 73.5 years, and 10 cases had diabetes mellitus. The average time between cataract surgery and diagnosis of endophthalmitis was 4.8 days, and in 16 cases the disease developed 2 days after surgery. Final visual acuity was better than 40/200 in 13 eyes and 20/200 to no light perception in 15 eyes. CONCLUSIONS: E. faecalis caused acute-onset endophthalmitis. The visual outcome of the patients can be divided into good and poor groups.

A Case of Foldable Artificial Iris Implantation for Treatment of Postcataract Surgery Aniridia.

We report an approach for managing acquired aniridia induced by intraoperative floppy iris syndrome (IFIS) during cataract surgery. An 81-year-old man with right blurred vision and photophobia symptoms was treated for extensive iris defects due to cataract surgery aniridia. The retained iris for the patient was observed at the 5-10 o'clock position, with the intraocular lens (IOL) inside the capsular bag. Although the aniridia symptoms were successfully addressed by the implantation of a foldable artificial iris (Iris Prosthesis: Ophtec [formerly Reper], Groningen, the Netherlands), the procedure subsequently caused endothelial damage. In summary, while the utilization of the foldable artificial iris can improve aniridia symptoms, further advances in the insertion technique are required.

Evaluation of the incidence of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor.

AIMS: To report the incidence of infectious and noninfectious endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor (VEGF) from a multicenter clinical trial in Japan. METHODS: A retrospective multicenter review of the data of patients who received intravitreal anti-VEGF injections between January 2007 and March 2011 was undertaken. Cases with the clinical diagnosis of endophthalmitis resulting from intravitreal injection were identified and reviewed. RESULTS: A total of 5,236 intravitreal anti-VEGF injections (1,209 intravitreal injections of bevacizumab, 3,827 injections of ranibizumab, and 200 injections of pegaptanib sodium) had been administered. Five patients (0.095%), all of whom had received bevacizumab, were diagnosed as having endophthalmitis after the intravitreal injection. All patients visited the institutes for re-examination within 1-2 days after the injection. Among the 5 patients, 2 (0.038%) were culture positive for Streptococcus oralis and Enterococcus faecalis, respectively. The remaining 3 eyes (0.057%) developed presumed noninfectious endophthalmitis. CONCLUSION: Although endophthalmitis is a rare complication associated with intravitreal injection, in this series intravitreal anti-VEGF injection caused infectious or noninfectious endophthalmitis at a relatively high frequency. Further investigations are needed to consider an appropriate injection protocol for minimizing the incidence rates of endophthalmitis, and to assess the optimal treatment protocol for intravitreal injection-related endophthalmitis although it was difficult to differentiate these two entities.

Clinical Outcome of Lentis Comfort Intraocular Lens Implantation.

PURPOSE: To evaluate visual outcome and patient satisfaction following Lentis Comfort intraocular lens (IOL) implantation. METHOD: This retrospective case series examined 68 eyes of 41 patients (mean age 72.0 ± 8.1 years) who underwent Lentis Comfort (LS-313 MF15, Oculentis GmbH, Berlin, Germany; Santen, Osaka, Japan) implantations. Patients were evaluated for visual acuity (VA) at several distances (0.3, 0.5 and 5 meters), refractive error, defocus curve and contrast sensitivity, in addition to answering a questionnaire on photic phenomena, visual discomfort and patient satisfaction. RESULTS: Uncorrected visual acuity was 0.05 ± 0.13 (logMAR) for distance, 0.23 ± 0.17 (logMAR) for intermediate, and 0.52 ± 0.20 (logMAR) for near. Defocus curve showed the binocular visual acuity attained was almost 20/20 within the range of +0.5 D to -1.5 D. Contrast sensitivity was within the normal range. The Lentis Comfort IOL tolerated astigmatism to some extent. Patient age could potentially be related to uncorrected visual acuity. Questionnaire results showed almost all patients were satisfied with Lentis Comfort IOL implantation. CONCLUSION: Lentis Comfort IOLs provided better visual function at far and intermediate distances.

Fixed-Combination Eye Drops Based on Fluorometholone Nanoparticles and Bromfenac/Levofloxacin Solution Improve Drug Corneal Penetration.

PURPOSE: The multi-instillation of three commercially available (CA) eye drops [fluorometholone (FL)-, bromfenac (BF)- and levofloxacin (LV)-eye drops] has been used to manage pain and inflammation post-intraocular surgery. However, the multi-instillation of these three eye drops causes corneal damage, and the FL drops have the disadvantage of low ocular bioavailability. To overcome these problems, we prepared fixed-combination eye drops based on FL nanoparticles (FL-NPs) and BF/LV solution (nFBL-FC), and evaluated the corneal toxicity and transcorneal penetration of the nFBL-FC eye drops. METHODS: FL powder was mixed in 2-hydroxypropyl-ß-cyclodextrin solution containing benzalkonium chloride, mannitol and methylcellulose, and milled with a Bead Smash 12 (5500 rpm for 30 s×30 times). The BF/LV solution was then added to the milled-dispersions to be used as nFBL-FC. The FL, BF and LV concentrations were measured by HPLC methods, and transcorneal penetration was evaluated in rabbits. RESULTS: The FL particle size in nFBL-FC was 40-150 nm, with only 0.0018% in liquid form. No aggregation of FL particles in the nFBL-FC was observed for 1 month. The viability of human corneal epithelial cells treated with nFBL-FC was remarkably higher than that of cells subjected to the multi-instillation of the corresponding three CA-eye drops. In addition, the corneal penetrations (AUC) of the FL, BF and LV in nFBL-FC were 4.9-, 1.8-, and 7.1-fold those of the corresponding CA-eye drops, respectively. Moreover, the caveolae-dependent endocytosis (CavME) inhibitor (nystatin) significantly prevented the transcorneal penetration of these drugs. CONCLUSION: We prepared fixed-combination eye drops based on FL-NPs and BF/LV solution (nFBL-FC), and show that high levels of FL-NPs and dissolved BF/LV (liquid drugs) can be delivered into the aqueous humor by the instillation of nFBL-FC. Further, we show that CavME is mainly related to the enhancement of transcorneal penetration of both the solid (NPs) and liquid drugs.

A Rare Case of Palpebral Cellulitis, a Variation of Pott's Puffy Tumor.

A rare case of palpebral cellulitis with simultaneous frontal sinusitis and osteomyelitis is reported. A healthy 45-year-old man presented with left upper eyelid swelling. He was given intravenous meropenem at the local hospital, but he failed to improve. Magnetic resonance imaging showed left frontal and maxillary sinusitis and upper palpebral cellulitis with an abscess. His temperature was 37.6°C, C-reactive protein was 1.36 mg/dL, thyroid hormone was elevated, left best-corrected visual activity was 1.2, and intraocular pressure was 25 mm Hg. He was then given cefazolin intravenously for 3 days but with no improvement. Therefore, the eyelid skin was incised. Postoperatively, the swelling improved significantly. Computed tomography demonstrated osteomyelitis of the left frontal sinus and osteolysis of the inferior wall. This case was considered a variation of Pott's puffy tumor. Bacterial cultures from the cellulitis abscess and sinusitis were negative. As for sinusitis, endoscopic sinusitis surgery (frontal sinus single sinus surgery [Draf III] and Kilian surgery) was performed. During 10 months of follow-up after the skin incision, no signs of recurrent eyelid swelling were observed.

High-resolution photoreceptor imaging analysis of patients with autosomal dominant retinitis pigmentosa (adRP) caused by HK1 mutation.

PURPOSE: The hexokinase 1 (HK1) gene encodes one of the four human hexokinases that play essential roles in glucose metabolism. Recently, several cases of E847K mutation in the HK1 gene were reported to cause inherited retinal dystrophy. The purpose of this study was to identify the phenotypical characteristics of patients with a recurrent E847K mutation in the HK1 gene. METHODS: Three generations of one family with autosomal dominant retinitis pigmentosa were examined. Whole exome sequencing was performed on the DNA. Fundus imaging by an adaptive optics fundus camera was used to obtain high-resolution photoreceptor images. RESULTS: Fundus examination of the proband showed degeneration of the mid-peripheral retina, and SD-OCT images showed an absence of the ellipsoid zone (EZ) and interdigitation zone (IZ) in the parafovea and more peripherally. SD-OCT images of the mother of the proband showed an absence of the EZ and IZ, and fundus autofluorescence images showed hypo-autofluorescence surrounding the macular region. One daughter of the proband had only mild night blindness, however, the density of the cone photoreceptors was reduced in the parafoveal region. Whole exome sequencing identified a heterozygous variant, E847K, in the HK1 gene. This variant was found to co-segregate with the disease in three family members. CONCLUSIONS: Although the systemic phenotypes were found to be associated with the HK1 mutations, only the E847K mutation can cause a non-syndromic photoreceptor degeneration. Our study strengthened the hypothesis that the amino acid E847 might play a critical role in the maintenance of the morphology and function of the photoreceptors.

Incidence of endophthalmitis and the perioperative practices of cataract surgery in Japan: Japanese Prospective Multicenter Study for Postoperative Endophthalmitis after Cataract Surgery.

PURPOSE: To prospectively survey the incidence of endophthalmitis following cataract surgery and investigate the current perioperative practices in Japan. METHODS: Patients who underwent cataract surgery from January 2012 to December 2013 were included. Information on perioperative practices were recorded prospectively. Clinical characteristics were examined in cases with endophthalmitis. RESULTS: A total of 63,244 patients who underwent cataract surgery in 205 facilities were enrolled. The detailed information about the current perioperative scenario surrounding cataract surgery in Japan was evaluated for the preoperative, intraoperative, and postoperative practices, i.e., patient background, prophylactic antibiotic regimen, modes of disinfection or disinfectant use, preoperative procedure, surgical method, surgical materials, surgical complication, or others. Postoperative endophthalmitis developed in 25 patients within 8 weeks postoperatively (incidence 0.04%). However, since outbreaks of toxic anterior segment syndrome (TASS) after implantation of intraocular lenses contaminated with aluminum (HOYA iSert 251 and 255) were reported, 10,261 cases implanted with the lenses had been excluded (as having a risk for non-infectious late-onset TASS). In the remaining 52,983 cases, postoperative endophthalmitis developed in 13 cases within 8 weeks postoperatively (incidence 0.025%). CONCLUSIONS: This prospective survey identified the current perioperative practices representing cataract surgery and the incidence of endophthalmitis following cataract surgery (0.025%) in Japan. We believe this information can serve as a guide for future improvement in risk-reduction strategies.

The relationship between the adhesion characteristics of acrylic intraocular lens materials and posterior capsule opacification.

PURPOSE: To investigate the relationship between the adhesion characteristics of similarly designed hydrophobic acrylic intraocular lenses (IOLs) and posterior capsule opacification (PCO). METHODS: Three similarly shaped hydrophobic acrylic IOLs with a sharp-edged optic were used. Adhesive force of IOLs was measured with a tackiness tester. Human lens epithelial cells (LECs) were grown on each IOL for 48 h. LECs were then stained with crystal violet, which served as an index of the amount of cells attached to IOLs. Cellular migration and proliferation assays were performed using chamber inserts containing a collagen membrane. After 96 h of incubation, the collagen membranes were stained with hematoxylin and eosin for analysis. Three similarly shaped IOLs were implanted in rabbits. The eyes were enucleated 3 weeks later and analyzed for PCO area. RESULTS: Hydrophobic acrylic IOLs were classified into three groups: A (less adhesive), B (moderately) and C (highly). The migration area of LECs on the collagen membrane was 5.65 +/- 4.5% in group A, 2.83 +/- 2.1% in group B, and 1.41 +/- 1.5% in group C, with a significant difference between groups A and C (p < 0.05). The mean percentage area of PCO in the rabbit eye was 19.4 +/- 16.7% in group A, 17.5 +/- 8.5% in group B, and 5.5 +/- 3.8% in group C, with a significant difference between groups A and C (p < 0.05). CONCLUSION: Adhesive force of hydrophobic acrylic IOLs may play an important role in preventing PCO. Among the similarly shaped hydrophobic acrylic IOLs, IOLs of highly adhesive material inhibited LEC migration and PCO more than IOLs of less adhesive material.

Postoperative Enterococcus faecalis endophthalmitis: virulence factors leading to poor visual outcome.

Purpose Postoperative endophthalmitis caused by Enterococcus faecalis often results in poor visual outcome due to retinal destruction. We evaluated the virulence factors of Enterococcus faecalis clinical isolates and analyzed their relationship with retinal destruction and poor visual outcomes in postoperative bacterial endophthalmitis (PBE) following cataract surgery. STUDY DESIGN: Retrospective. METHODS: E. faecalis isolates from nine acute-onset PBE cases were examined using pulsed-field gel electrophoresis of genomic DNA, plasmid isolation and pheromone response experiments. Virulence determinant genes, including cytolysin (cylA), aggregation substance (asa1), enterococcal surface protein (esp), gelatinase (gelE) and adhesin of collagen from enterococci (ace), were examined by polymerase chain reaction. Expression of cytolysin and secreted protease were also tested. Retinal findings observed during vitrectomy surgery and final visual acuities were compared to obtained microbiological data. Poor visual outcome was defined as final visual acuity of less than 0.1 (decimal). RESULTS: Although nine isolates were collected, two were identical. Out of the eight different isolates, three were positive for both expressions of cytolysin and secreted proteases. Plasmid DNAs were isolated from six of eight isolates, while pheromone response was observed in five isolates. The asa1, esp and ace genes were positive in six, five and eight of the isolates, respectively. Patients with retinal destruction exhibited significantly higher prevalence of secreted protease expression versus those without (P < 0.05), and retinal destruction was related to poor visual outcome (P < 0.05). CONCLUSIONS: Our data suggest that enterococcal secreted proteases were correlated to retinal destruction, thereby fostering poor visual outcomes in eyes with enterococcal endophthalmitis.

Biofilm formation by Staphylococcus epidermidis on intraocular lens material.

PURPOSE: To compare biofilm formation by Staphylococcus epidermidis on different intraocular lens (IOL) materials. METHODS: The S. epidermidis strains, ATCC 12228 (American Type Culture Collection) and ATCC 35984 (biofilm-producer) were used. Biofilms were cultivated on disks of different IOL materials: silicone, PMMA (polymethylmethacrylate), acrylic, or MPC (2-methacryloyloxyethyl phosphorylcholine) surface-modified acrylic. Biofilms were stained with crystal violet (CV) which served as an index of biofilm formation. The bacterial population was enumerated after biofilm homogenization. Biofilms were also examined by scanning electron microscopy (SEM). RESULTS: Among the four materials tested, the least amount of biofilm formed on silicone. Biofilm production was significantly different between acrylic and MPC surface-modified acrylic lenses at 48 hours (P<0.05-0.01). The bacterial populations were significantly different between acrylic and silicone over 72 hours (P<0.05-0.01). The population on acrylic and MPC surface-modified acrylic continued to increase over 72 hours. The biofilm was recognized after a 24-hour incubation. Rates of biofilm-positive SEM fields, which were defined as being occupied by biofilm over at least half of the area, were significantly different between acrylic and silicone at 72 hours (P<0.05-0.01). CONCLUSIONS: S. epidermidis formed biofilm most intensely on acrylic among the four IOL materials tested. MPC surface-modified acrylic has a preventive effect on biofilm formation.

Biofilm formation on hydrophilic intraocular lens material.

PURPOSE: To estimate bacterial biofilm formation on the hydrophilic acrylic (hydrogel) intraocular lens (IOL) Meridian (HP60M, Baush & Lomb) and to investigate a preventive effect against biofilm formation of hydrogel IOLs presoaked in antibiotics. METHODS: Two Staphylococcus epidermidis strains, ATCC 12228 and ATCC 35984 (biofilm-producer), and an Enterococcus faecalis strain (KOS1, clinical isolate from an endophthalmitis patient) were used. Biofilms were cultivated on disks of different IOL materials: hydrogel, PMMA (polymethylmethacrylate), and acrylic. Biofilms were stained with crystal violet (CV), which served as an index of biofilm formation. The bacterial population was enumerated after biofilm homogenization. Biofilms were also examined by scanning electron microscopy (SEM). IOLs were presoaked in two antibiotics, levofloxacin (LVFX) and gatifloxacin (GFLX), and then the bacterial population was enumerated. As in vivo experiment, antibiotics-treated and nontreated Meridian IOLs were implanted in rabbit eyes, which served as an endophthalmitis model, and the bacterial population was enumerated. RESULTS: The amount of biofilm formed was the least on hydrogel from among the three materials tested after 48- and 72-hr incubation (p < 0.05 to 0.01). The bacterial population was the least on hydrogel from among the three materials with ATCC 12228 (p < 0.05 to 0.01), and the bacterial population was significantly different between hydrogel and acrylic after 72-hr incubation with ATCC 35984 (p < 0.05). Biofilm by the two S. epidermidis strains were recognized after 24-hr incubation. Rates of biofilm-positive SEM fields, which were defined as being occupied by biofilm over at least half of the area, were increased through 72 hr with ATCC 35984. While the E. faecalis strain showed no bacterial adherence on the antibiotics-treated hydrogel IOLs, adherence of the S. epidermidis strain, ATCC 35984 was recognized on the LVFX-treated IOLs after 48-hr incubation (103 to 104 CFU/ml). In the rabbit in vivo model, the bacterial populations in eyes with an antibiotics-treated Meridian IOL were significantly smaller than in eyes with a nontreated IOL for 72 hr after surgery (p < 0.05 to 0.01). CONCLUSIONS: The biofilm formation was less on hydrogel than on other two materials tested. Hydrogel presoaked in antibiotics exhibited a preventive effect against biofilm formation at least for 24 hr in vitro and against bacterial proliferation in the rabbit in vivo endophthalmitis model.

[Scanning electron microscope of for endophthalmitis case].

PURPOSE: The purpose of this study was to demonstrate the usefulness of the scanning electron microscope in examining the posterior capsule and an intraocular lens (IOL) in an endophthalmitis patient. METHODS: The patient was a 77-year-old man with diabetes mellitus undergoing radiotherapy for prostatic carcinoma, and having a history of esophageal cancer. Phacoemulsification, aspiration and IOL insertion by keratotomy were carried out. The operation was performed without complications. The IOL was a one-piece acrylic type. However, after 24 hours, we diagnosed acute bacterial endophthalmitis, because the patient showed visual loss, high intraocular pressure, fibrin formation, and an increase of cells in the anterior chamber. Vitrectomy to remove the IOL and posterior capsule was carried out on the same day. The removed samples were observed by scanning electron microscope. RESULTS: Enterococcus faecalis was detected in the vitreous and aqueous humor. The bacteria adhered to the optic and haptic surfaces and showed biofilm formation. The traces of the end mill cutting line were recognized beside the haptics. However, the posterior capsule showed no bacterial adhesion but had an unusual shape. CONCLUSIONS: We observed the biofilm formation in an IOL removed from an acute bacterial endophthalmitis case. An IOL may be an important canse of bacterial proliferation and adhesion.

Biofilm formation by Enterococcus faecalis on intraocular lens material.

PURPOSE: To compare biofilm formation by Enterococcus faecalis on different intraocular lens (IOL) materials. METHODS: E. faecalis biofilms were cultivated on disks of IOL material (silicone, PMMA [polymethylmethacrylate], or acrylic). Biofilms were stained with crystal violet (CV), which served as an index of biofilm formation. The bacterial population was enumerated after biofilm homogenization. Biofilms were also examined by confocal microscopy. RESULTS: At 24 hr, there was no significant difference in biofilm formation, or the population within biofilms, among the three materials tested. However, after 48 and 72 hr, it was observed that silicone supported the least amount of biofilm formation (p < 0.05); biomass on PMMA and acrylic IOLs continued to increase, with acrylic demonstrating the greatest amount of stainable biofilm (p < 0.0005). The population on PMMA was significantly greater than the other IOL materials (p < 0.005). Confocal microscopy confirmed the lack of biomass on silicone. CONCLUSIONS: Among three IOL materials, E. faecalis biofilms formed more readily on PMMA and acrylic compared to silicone.

Development and efficacy of a drug-releasing soft contact lens.

PURPOSE: The purpose of this study was to investigate the uptake and the release of antibiotics from a newly synthesized drug delivery hydrogel soft contact lens (SCL) using an ion ligand mechanism. METHODS: The antibiotics used were Gatifloxacin (GFLX) and Moxifloxacin (MFLX). The uptake amount and the sustained-release kinetics of antibiotics were investigated in vitro, and were also compared with newly synthesized SCLs, etafilcon A and polymacon. The antibiotic concentrations in the cornea, aqueous humor, and crystalline lens, and the effect against bacterial proliferation were investigated in vivo using rabbit subjects. Additionally the drug release efficacy of the new SCL was compared with that of eye drop administrations. RESULTS: In vitro, antibiotic uptake was increased with the weight percent (wt%) of the anionic group, and the released amount of antibiotics was highest during the initial 1 hour period, which then decreased over the next 72 hours. The released antibiotics volume of the new SCLs was significantly higher throughout 72 hours than that of the other two materials, etafilcon A and polymacon (P < 0.01). Whereas in vivo, the concentrations found in the cornea and aqueous humor were higher than those for the eye drop groups (P < 0.05 or P < 0.01). Antibiotic release at those sites decreased over 72 hours. No bacterial populations were detectable in the group treated with the new SCL presoaked in antibiotics throughout the experimental periods. CONCLUSIONS: The new SCLs released the antibiotics over several days, and showed improved penetration into the eye, along with prevention of bacterial proliferation.

Calcification and membrane formation on the surface of intraocular lenses in a rabbit model.

PURPOSE: The aim of this study is to evaluate the calcification and membrane formation in different intraocular lenses (IOLs) models by implanting the IOLs in the subcutaneous plane of a Rabbit model. DESIGN: Experimental study. METHODS: IOLs were implanted subcutaneously in 13 Japanese albino rabbits for 1 month (n = 6), 3 months (n = 4) and 6 months (n = 3). Five kinds of IOLs were used, including three hydrophobic acrylic IOLs, the MA60AC (Alcon), ZA9003 (AMO) and X-60 (Santen), and two hydrophilic acrylic IOLs, the HP60M and MI60 (Bausch & Lomb). Scanning electron microscopy was used to observe the IOL optics. Energy dispersive x-ray spectroscopy and infrared spectroscopy were used to analyse any surface depositions on the optics, and the modulation transfer function was applied to evaluate the optical performance. RESULTS: Membrane formation was noted to have occurred on the surfaces of the two hydrophobic acrylic IOLs (MA60AC and ZA9003) during the investigation period. The membrane components originated from a serum protein that most likely would be serum albumin. Calcification was noted to have occurred on the surfaces of the two hydrophilic IOLs. However, no calcification was observed on the hydrophobic IOLs, nor was there any membrane formation on the hydrophilic IOLs. The values for the MI60 were not measurable at all at 3 or 6 months. The values of the three hydrophobic IOLs were significantly better than the value for the HP60M at three and six months (p < 0.01). CONCLUSION: Calcification to the hydrophilic IOLs severely affected optical performance, whereas, membrane formation on the hydrophobic IOLs did not affect optical performance. The X-60 had the optics that best maintained long-term transparency.

Comparison of the influence of intracameral gentamicin, gatifloxacin, and moxifloxacin on the corneal endothelium in a rabbit model.

PURPOSE: To compare the effect of three intracameral antibiotics, gentamicin (GM), gatifloxacin (GFLX), and moxifloxacin (MFLX), on the rabbit corneal endothelium. METHODS: Twenty-four eyes from 18 rabbits were used. In the GM treatment group of 12 eyes, a dose of 20 mg/ml, 2 mg/ml, 200 µg/ml, or 20 µg/ml of GM was injected into the anterior chamber. In the GFLX and MFLX treatment groups were injected into the anterior chamber of three eyes. The central corneal thickness was measured. The eyes were then enucleated for observation under scanning electron microscopy. RESULTS: Three days after the intracameral injection, a significant difference in central corneal thickness was found between the GM 20 mg/ml group and the control group (P < 0.05), but not between any other groups. The damage rate at the endothelial cell level was 67% in the GM 20 mg/ml group, 56% in the GM 2 mg/ml group, 33% in the GM 200 µg/ml group, 22% in the GM 20 µg/ml group, 22% in the GFLX group, and 0% in the MFLX group. CONCLUSIONS: Intracameral GFLX or MFLX was almost nontoxic to the rabbit corneal endothelium, in contrast to the toxic results of intracameral GM 20 and 2 mg/ml.

Aqueous humor penetration of fourth-generation fluoroquinolone ophthalmic solutions given by multiple administration in a rabbit model.

We investigated the aqueous humor concentration of topically applied gatifloxacin (GFLX) 0.3% and moxifloxacin (MFLX) 0.5% in a rabbit model of surgical and nonsurgical eyes. Topical administration in eyes was performed eight times, at 15-min intervals. Surgical eyes had undergone cataract surgery with the implantation of an intraocular lens (IOL). Aqueous humor was sampled at 5, 30, and 120 min after drug administration. Drug concentrations were determined by high-performance liquid chromatography (HPLC). The GFLX concentrations in surgical eyes at 5, 30, and 120 min post-administration were 12.1, 14.0, and 6.1 microg/ml, and those in nonsurgical eyes were 11.3, 11.5, and 7.1 microg/ml; there were no differences between surgical and nonsurgical eyes. The concentrations of MFLX in surgical eyes were 46.2, 42.7, and 31.1 microg/ml. The concentration of MFLX was higher than that of GFLX at 5 and 120 min post-administration (P < 0.05). A multiple-drop schedule produced much higher aqueous concentrations. There was no difference in drug penetration in eyes that had undergone cataract surgery compared with nonsurgical eyes.

Preventive effect against post-cataract endophthalmitis: drug delivery intraocular lens versus intracameral antibiotics.

PURPOSE: To compare hydrophilic acrylic intraocular lenses (IOLs) as an antibiotic drug-delivery system with intracameral antibiotic administration in terms of the ability to prevent endophthalmitis. METHODS: Antibiotic solutions of 0.3% (3 mg/ml) and 0.5% (5 mg/ml) gatifloxacin (GFLX) and 0.5% (5 mg/ml) and 1.5% (15 mg/ml) levofloxacin (LVFX) were prepared. IOLs made of hydrophilic acrylic and silicone were used. Hydrophilic acrylic IOLs were allowed to adsorb the antibiotic solutions. A clinically isolated strain, KOS1, of Enterococcus faecalis was used to induce experimental endophthalmitis in vivo. Antibiotic concentrations were determined with high-performance liquid chromatography (HPLC). Twelve hydrophilic acrylic IOLs with antibiotics were used for the in vitro antibiotic concentration assay. In vivo experiments were conducted with 51 rabbits in total. Antibiotic concentrations in the aqueous humor and effects against bacterial proliferation were evaluated. RESULTS: Concentrations of released antibiotics in vitro were highest on the first day and had decreased by the second day. When a comparison was made between similar initial concentrations, GFLX was released to a significantly higher concentration than LVFX (p < 0.001). In the antibiotic-treated IOL group, GFLX concentrations in the aqueous humor reached a peak at four hours postoperatively and then decreased. The intracameral antibiotic group showed similar tendencies, with a remarkably higher peak concentration. Effects against bacterial proliferation were comparable between the antibiotic-treated IOLs and intracameral antibiotic administration. CONCLUSIONS: Preventive effects against endophthalmitis were similar between antibiotic-treated IOL implantation and intracameral antibiotic administration.