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A Novel Anti-infective Prophylaxis Approach for Cataract Surgery

José A. Cardillo, MD; Fernando Paganelli, MD; Luiz A. S. Melo Jr, MD; Arnobio A. Silva Jr, PharmD; Antonio C. Pizzolitto, PharmD; Anselmo G. Oliveira, PharmD, PhD; the Brazilian Ocular Pharmacology and Pharmaceutical Technology Research Group

Arch Ophthalmol. 2010;128(1):81-87. doi:10.1001/archophthalmol.2009.352

Objective  To compare the efficacy of subconjunctival injection of a combination of triamcinolone and ciprofloxacin hydrochloride, 2 mg/0.1 mL, in a controlled-release system (DuoCat) with that of ciprofloxacin hydrochloride, 0.3%, eyedrops for infection prophylaxis.

Methods  Rabbit eyes were injected subconjunctivally with a combination of triamcinolone and ciprofloxacin hydrochloride, 2 mg/0.1 mL, or ciprofloxacin hydrochloride, 2 mg/0.1 mL, alone. The aqueous and vitreous humor pharmacokinetic profiles were compared with those of a single drop of ciprofloxacin hydrochloride, 0.3%, 6 times daily. In 45 rabbits, Staphylococcus aureus was injected into the anterior chamber: 15 randomly received 1 drop of ciprofloxacin hydrochloride, 0.3%, every 4 hours during 24 hours; 15 received drops of balanced salt solution; and 15 received a combination of triamcinolone and ciprofloxacin hydrochloride, 2 mg/0.1 mL. After 24 hours, endophthalmitis scores were recorded, aqueous and vitreous humors underwent culture, and histologic analysis was performed.

Results  The combined triamcinolone and ciprofloxacin treatment allowed higher intraocular levels of ciprofloxacin. The median endophthalmitis clinical scores for the combination of triamcinolone and ciprofloxacin and ciprofloxacin-only eyedrop groups were equivalent (P = .42) and were significantly lower than those of the balanced salt solution group (P < .001). The culture was negative for S aureus in the combined triamcinolone and ciprofloxacin and ciprofloxacin eyedrop regimens. No adverse effects were observed with either route.

Conclusions  Ciprofloxacin eyedrops and combined triamcinolone and ciprofloxacin were equally tolerated and efficacious. The combined triamcinolone and ciprofloxacin treatment may eliminate noncompliance issues and may prove to be a valuable clinical tool for surgical prophylaxis.

Clinical Relevance  The combined triamcinolone and ciprofloxacin treatment may be a new useful strategy for surgical prophylaxis.

Author Affiliations: Hospital de Olhos de Araraquara, Araraquara (Drs Cardillo and Paganelli); Department of Ophthalmology, Federal University of São Paulo–UNIFESP-EPM (Drs Cardillo, Paganelli, and Melo); Department of Ophthalmology, University of Araraquara–UNIARA, Araraquara (Drs Cardillo and Paganelli); and School of Pharmaceutical Sciences, State of São Paulo University–UNESP, Araraquara (Drs Silva, Pizzolitto, and Oliveira), São Paulo, Brazil.

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