Delayed Epithelial Closure After PRK Associated With Topical Besifloxacin Use

Talamo, Jonathan H.; Hatch, Kathryn M; Woodcock, Emily C

doi:10.1097/ico.0b013e31829e1e8c

Cited by 7 publications

(5 citation statements)

References 4 publications

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“…This maintains the concentrated BAK in contact with the corneal surface for a prolonged period, which may result in increased toxicity. 35–37 The use of ketotifen and besifloxacin also coincides with our patient’s worst symptoms.…”

Section: Discussionsupporting

confidence: 66%

Delayed Epithelial Healing with Corneal Edema and Haze After Photorefractive Keratectomy Using Intraoperative Mitomycin C

Moshirfar¹,

West²,

Milner³

et al. 2021

IMCRJ

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We report an unusual presentation of presumed mitomycin C toxicity with possible subsequent hypersensitization to other medication toxicities. A 50-year-old female presented three months after photorefractive keratectomy with intraoperative mitomycin C for the management of persistent epithelial defects, corneal haze, and edema. She was found to have used an expansive and rapidly changing medical regimen which may have caused additional toxicity. These medications included besifloxacin, bromfenac, and ketotifen. Additives such as benzalkonium chloride and DuraSite ® may have also contributed. Intraoperative mitomycin C can result in longstanding corneal haze, edema, and delayed epithelial healing in the setting of corneal refractive surgery. These may leave the cornea more susceptible to additional subsequent medication toxicities during the postoperative period. This report describes a case of mitomycin C exposure leading to a prolonged sensitivity to other medication toxicities, which has not been discussed elsewhere in the literature.

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Section: Discussionsupporting

confidence: 66%

Delayed Epithelial Healing with Corneal Edema and Haze After Photorefractive Keratectomy Using Intraoperative Mitomycin C

Moshirfar¹,

West²,

Milner³

et al. 2021

IMCRJ

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“…However, problems with the prophylactic use of besifloxacin in the surgical setting have been reported under particular circumstances. Talamo et al [ 91 ] reported delayed epithelial closure (5 to 13 days, with an average of 8.8 days) and delayed visual recovery in a case series of 4 patients (7 eyes) treated with besifloxacin 0.6% instilled underneath a bandage contact lens (BCL) placed at the conclusion of photorefractive keratectomy (PRK) [ 91 ]. These adverse reactions were attributed by the authors to potential toxic effects of DuraSite or the preservative benzalkonium chloride 0.01% on exposed corneal stroma, especially when drug contact time is prolonged.…”

Section: Resultsmentioning

confidence: 99%

Besifloxacin: Efficacy and Safety in Treatment and Prevention of Ocular Bacterial Infections

Mah

Sanfilippo²

2016

Ophthalmol Ther

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This comprehensive review summarizes the mechanism of action, pharmacokinetics, efficacy, and safety of besifloxacin ophthalmic suspension, 0.6% and examines its role in the treatment of ocular surface bacterial infections. Besifloxacin possesses balanced activity against bacterial topoisomerase II (also called DNA gyrase) and topoisomerase IV. It has shown a low potential to select for bacterial resistance in vitro and demonstrated strong in vitro activity against many Gram-positive, Gram-negative, and anaerobic organisms, including methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis (MRSA and MRSE, respectively). Ocular pharmacokinetic studies have shown that besifloxacin achieves high, sustained concentrations in the tear fluid and conjunctiva following topical administration, with negligible systemic exposure. Large randomized, controlled clinical trials have established the efficacy and safety of besifloxacin administered three times daily for 5 days for treatment of acute bacterial conjunctivitis in both adults and children, with high rates of clinical resolution (up to more than 70% by day 5) and bacterial eradication (more than 90% by day 5), and a low incidence of adverse events. Additionally, besifloxacin applied twice daily for 3 days demonstrated greater efficacy than vehicle in treating bacterial conjunctivitis. Case reports, a large retrospective chart review, and animal studies have provided supporting evidence for the efficacy of besifloxacin in the management of acute bacterial keratitis. There is some evidence to suggest that besifloxacin may provide an advantage over other current-generation fluoroquinolones in antimicrobial prophylaxis for ocular surgery. Besifloxacin is an appropriate option for treatment of bacterial conjunctivitis, and its use in the treatment of bacterial keratitis and lid disorders, as well as for surgical prophylaxis, appears promising and warrants further evaluation.

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“…Delay in postoperative re-epithelialization has been shown to increase the risk of infection and haze after PRK. 19 One eye in the Tars_DCL 4wk group and one of the contralateral eyes (that had PRK and no other intervention) had an epithelial defect at postoperative week 1 both of which re-epithelialized the following week. By contrast, 3 eyes of 6 eyes in the Tars group (n = 6) had epithelial defects at postoperative week 1.…”

Section: Safetymentioning

confidence: 96%

Dexamethasone-Eluting Contact Lens for the Prevention of Postphotorefractive Keratectomy Scar in a New Zealand White Rabbit Model

Soeken

Ross

Kohane

et al. 2021

Cornea

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Purpose: To evaluate the safety and efficacy of an experimental dexamethasone-eluting contact lens (DCL) for the prevention of postphotorefractive keratectomy (PRK) corneal haze in a New Zealand White (NZW) rabbit model. Methods:Both eyes of 29 NZW rabbits underwent PRK. The rabbits were randomized to one of the 5 study arms for 4 weeks: tarsorrhaphy only, tarsorrhaphy and bandage contact lens (BCL) replaced weekly, tarsorrhaphy and BCL for 1 week plus topical 0.1% dexamethasone ophthalmic solution (drops) for 4 weeks, tarsorrhaphy and BCL replaced weekly plus topical dexamethasone for 4 weeks, and tarsorrhaphy and DCL changed weekly for 4 weeks. Each week for 4 consecutive weeks postoperatively, the tarsorrhaphies were opened, the eyes underwent evaluation and imaging, and the tarsorrhaphies were replaced. Contact lenses were cultured on removal. Central corneal haze was assessed weekly with corneal densitometry. After 4 weeks, the animals were killed, and the eyes were enucleated for histopathologic analysis. Results:The tarsorrhaphy only group displayed more haze with a greater change in optical densitometry from pre-op compared with the other treatment groups. There was no difference between the DCL group and the groups receiving a BCL and dexamethasone drops in densitometry or histopathology. No NZW rabbits developed clinical signs of infection, and cultures from DCLs and BCLs grew similar organisms. Conclusions:In the post-PRK rabbit model, DCLs worn weekly for 4 weeks were safe and as effective at preventing corneal haze as 0.1% dexamethasone drops applied 4 times a day for 4 weeks.

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Delayed Epithelial Closure After PRK Associated With Topical Besifloxacin Use

Cited by 7 publications

References 4 publications

Delayed Epithelial Healing with Corneal Edema and Haze After Photorefractive Keratectomy Using Intraoperative Mitomycin C

Delayed Epithelial Healing with Corneal Edema and Haze After Photorefractive Keratectomy Using Intraoperative Mitomycin C

Besifloxacin: Efficacy and Safety in Treatment and Prevention of Ocular Bacterial Infections

Dexamethasone-Eluting Contact Lens for the Prevention of Postphotorefractive Keratectomy Scar in a New Zealand White Rabbit Model

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