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Pupil Size Differences Noted With Moxifloxacin and Gatifloxacin Before Eye Surgery: Presented at ARVO

By Ed Susman

FORT LAUDERDALE, Fla -- May 5, 2008 -- Patients who are treated with the antibiotic moxifloxacin 0.5% before having cataract surgery appear to have a significant reduction in pupil size, while there appears to be no significant change in pupil size in patients treated with gatifloxacin 0.3% before surgery.

However, researchers who compared the effects of the 2 antibiotics in patients undergoing cataract surgery in a prospective, randomised study found no statistical difference in rates of conjunctival hyperaemia, ocular irritation, or pain with the 2 agents.

The findings were presented here at the 2008 Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO).

Amaryllis Avakian, MD, Staff Ophthalmologist, University of Sao Paolo School of Medicine, Sao Paolo, Brazil, and colleagues enrolled 60 patients who received preoperative ophthalmic antibiotic prophylaxis before undergoing cataract surgery.

Among the 60 eyes treated with antibiotic drops, there was a significant reduction from baseline in mean pupil size in the eyes that received moxifloxacin 0.5% (P < .05) and no significant change in the eyes that received gatifloxacin, Dr. Avakian said.

"The effect of 0.3% gatifloxacin in the pupil size can have a beneficial influence in the surgical outcome," she added.

"The goal of developing an ophthalmic antibiotic is to provide broad-spectrum, high-potency antimicrobial efficacy and ocular penetration with an agent that is well tolerated, nontoxic, and noninflammatory," Dr. Avakian said in her poster presentation on April 29.

"The new generation of fluoroquinolones -- moxifloxacin, and gatifloxacin -- have a broad-spectrum coverage against gram-positive and gram-negative bacteria, better penetration into the ocular tissues, without the high resistant patterns observed in earlier generations," Dr. Avakian said. "For these reasons, they are being used as prophylaxis prior to cataract and refractive surgery."

The researchers compared commercially available ophthalmic solutions of gatifloxacin 0.3% with benzalkonium chloride and moxifloxacin 0.5% without benzalkonium chloride and measured several parameters of ocular tolerability in patients undergoing cataract procedures.

Dr. Avakian and colleagues enrolled patients who were scheduled for routine phacoemulsification. In a double-masked fashion, 30 patients received moxifloxacin 0.5% and 30 patients were dosed with gatifloxacin 0.3% 1 drop every 15 minutes 4 times before the surgical procedure.

Ocular side effects were scored in both groups using to a numerical scale of 1 to 15. Patients were submitted to slit-lamp examination 5 minutes after the last application. Pupil size and conjunctival hyperaemia were scored by a single observer who did not administer the drops and who was masked to the treatment administered. Ocular irritation and pain were scored by the patient.

Moxifloxacin treatment resulted in a 0.6-mm decrease in pupil size from baseline, while gatifloxacin treatment increased pupil size by 0.2 mm from baseline, Dr. Avakian reported.

There was no statistical difference between treatment groups in conjunctival hyperaemia ocular irritation, and in patients' pain scores, suggesting that both agents are well tolerated, she said.

The preservative in the commercially available gatifloxacin 0.3% contains 0.005% benzalkonium chloride, which was apparently well tolerated at this concentration, she added.

[Presentation title: Comparison of Ocular Side Effects Between 0.3% Gatifloxacin and 0.5% Moxifloxacin. Poster D1061]

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