Postoperative Contamination After Using Vancomycin and Gentamicin During Phacoemulsification

Pharmacokinetics of vancomycin following intracameral bolus injection in patients undergoing phacoemulsification cataract surgery

“…Ferro and colleagues found a 47% decrease in aqueous vancomycin concentration within 2 hours of completing phacoemulsification surgery using vancomycin 20 mg/l in the infusion, indicating an elimination half-life of approximately 2 hours early in the postoperative period,6 a finding that has been verified by Mendivil et al 14. In the present study, the half-life of vancomycin in the anterior chamber was estimated to be approximately 3 hours 16 minutes.…”

“…In a recent in vitro study, Libre et al found that vancomycin was bacteristatic for the first 6 hours and only became bactericidal after 8 hours, a finding that is consistent with a mechanism of action that blocks cell wall synthesis 21 22. This may also explain why vancomycin in the irrigating infusion has been shown to have no significant effect on aqueous contamination after cataract surgery as the aqueous concentration drops below the MIC within 5 hours and therefore well before bactericidal activity has been achieved 6 12. Vancomycin has a slower kill-time curve than the β-lactam antibiotics, which also act by inhibiting bacterial cell wall synthesis and include the penicillins and cephalosporins 23.…”

Pharmacokinetics of vancomycin following intracameral bolus injection in patients undergoing phacoemulsification cataract surgery

“…Ferro and colleagues found a 47% decrease in aqueous vancomycin concentration within 2 hours of completing phacoemulsification surgery using vancomycin 20 mg/l in the infusion, indicating an elimination half-life of approximately 2 hours early in the postoperative period,6 a finding that has been verified by Mendivil et al 14. In the present study, the half-life of vancomycin in the anterior chamber was estimated to be approximately 3 hours 16 minutes.…”

“…In a recent in vitro study, Libre et al found that vancomycin was bacteristatic for the first 6 hours and only became bactericidal after 8 hours, a finding that is consistent with a mechanism of action that blocks cell wall synthesis 21 22. This may also explain why vancomycin in the irrigating infusion has been shown to have no significant effect on aqueous contamination after cataract surgery as the aqueous concentration drops below the MIC within 5 hours and therefore well before bactericidal activity has been achieved 6 12. Vancomycin has a slower kill-time curve than the β-lactam antibiotics, which also act by inhibiting bacterial cell wall synthesis and include the penicillins and cephalosporins 23.…”

In vitro influence of vancomycin on adhesion of a Staphylococcus epidermidis strain encoding intercellular adhesion locus ica to intraocular lenses

“…38 A current practice of many surgeons is to add vancomycin to the infusion during cataract surgery, despite its failure to reduce bacterial concentration in the aqueous humor (ie, the number of intraocular cultures positive for microorganisms), at the end of surgery 23 or at 2 hours postoperatively. 22 Our results, however, prove that the number of positive aqueous humor taps does not suitably measure the antibiotic prophylactic efficiency of vancomycin brought by irrigation. In fact, it only quantifies the early bactericidal activity, which may not be the only prophylactic effect of vancomycin.…”

Safety of prophylactic intracameral moxifloxacin 0.5% ophthalmic solution in cataract surgery patients

“…Unfortunately, there is a dearth of data in the literature on the bioavailability of antibiotics after intraocular administration in humans. [32][33][34] Furthermore, the data in these studies are not entirely conclusive as a result of unavoidable limitations in aqueous humor sampling. Because of the small volume of aqueous, which prevents repeated extractions, these studies evaluated antibiotic concentrations in different patients at different times.…”

“…The actual half-drop in concentration, however, may be closer to 1 to 2 hours, as reported for irrigation fluid antibiotics. [32][33][34] If these data reflect actual circumstances and if presumed constant elimination rates based on available information are to be believed (T.P. O'Brien, MD, ''Vigamox Protects Against Staph Isolates in Cataract Surgery Patients,'' EyeWorld, October 2005, 10[suppl]), moxifloxacin levels in the aqueous exceeding MICs for relevant species will persist for a conservatively estimated time of 5 hours.…”

Pharmacokinetics of vancomycin following intracameral bolus injection in patients undergoing phacoemulsification cataract surgery

“…Ferro and colleagues found a 47% decrease in aqueous vancomycin concentration within 2 hours of completing phacoemulsification surgery using vancomycin 20 mg/l in the infusion, indicating an elimination half-life of approximately 2 hours early in the postoperative period,6 a finding that has been verified by Mendivil et al 14. In the present study, the half-life of vancomycin in the anterior chamber was estimated to be approximately 3 hours 16 minutes.…”

“…In a recent in vitro study, Libre et al found that vancomycin was bacteristatic for the first 6 hours and only became bactericidal after 8 hours, a finding that is consistent with a mechanism of action that blocks cell wall synthesis 21 22. This may also explain why vancomycin in the irrigating infusion has been shown to have no significant effect on aqueous contamination after cataract surgery as the aqueous concentration drops below the MIC within 5 hours and therefore well before bactericidal activity has been achieved 6 12. Vancomycin has a slower kill-time curve than the β-lactam antibiotics, which also act by inhibiting bacterial cell wall synthesis and include the penicillins and cephalosporins 23.…”

In vitro influence of vancomycin on adhesion of a Staphylococcus epidermidis strain encoding intercellular adhesion locus ica to intraocular lenses

“…38 A current practice of many surgeons is to add vancomycin to the infusion during cataract surgery, despite its failure to reduce bacterial concentration in the aqueous humor (ie, the number of intraocular cultures positive for microorganisms), at the end of surgery 23 or at 2 hours postoperatively. 22 Our results, however, prove that the number of positive aqueous humor taps does not suitably measure the antibiotic prophylactic efficiency of vancomycin brought by irrigation. In fact, it only quantifies the early bactericidal activity, which may not be the only prophylactic effect of vancomycin.…”

Safety of prophylactic intracameral moxifloxacin 0.5% ophthalmic solution in cataract surgery patients

“…Unfortunately, there is a dearth of data in the literature on the bioavailability of antibiotics after intraocular administration in humans. [32][33][34] Furthermore, the data in these studies are not entirely conclusive as a result of unavoidable limitations in aqueous humor sampling. Because of the small volume of aqueous, which prevents repeated extractions, these studies evaluated antibiotic concentrations in different patients at different times.…”

“…The actual half-drop in concentration, however, may be closer to 1 to 2 hours, as reported for irrigation fluid antibiotics. [32][33][34] If these data reflect actual circumstances and if presumed constant elimination rates based on available information are to be believed (T.P. O'Brien, MD, ''Vigamox Protects Against Staph Isolates in Cataract Surgery Patients,'' EyeWorld, October 2005, 10[suppl]), moxifloxacin levels in the aqueous exceeding MICs for relevant species will persist for a conservatively estimated time of 5 hours.…”

Pharmacokinetics of vancomycin following intracameral bolus injection in patients undergoing phacoemulsification cataract surgery

“…Ferro and colleagues found a 47% decrease in aqueous vancomycin concentration within 2 hours of completing phacoemulsification surgery using vancomycin 20 mg/l in the infusion, indicating an elimination half-life of approximately 2 hours early in the postoperative period,6 a finding that has been verified by Mendivil et al 14. In the present study, the half-life of vancomycin in the anterior chamber was estimated to be approximately 3 hours 16 minutes.…”

“…In a recent in vitro study, Libre et al found that vancomycin was bacteristatic for the first 6 hours and only became bactericidal after 8 hours, a finding that is consistent with a mechanism of action that blocks cell wall synthesis 21 22. This may also explain why vancomycin in the irrigating infusion has been shown to have no significant effect on aqueous contamination after cataract surgery as the aqueous concentration drops below the MIC within 5 hours and therefore well before bactericidal activity has been achieved 6 12. Vancomycin has a slower kill-time curve than the β-lactam antibiotics, which also act by inhibiting bacterial cell wall synthesis and include the penicillins and cephalosporins 23.…”

In vitro influence of vancomycin on adhesion of a Staphylococcus epidermidis strain encoding intercellular adhesion locus ica to intraocular lenses

“…38 A current practice of many surgeons is to add vancomycin to the infusion during cataract surgery, despite its failure to reduce bacterial concentration in the aqueous humor (ie, the number of intraocular cultures positive for microorganisms), at the end of surgery 23 or at 2 hours postoperatively. 22 Our results, however, prove that the number of positive aqueous humor taps does not suitably measure the antibiotic prophylactic efficiency of vancomycin brought by irrigation. In fact, it only quantifies the early bactericidal activity, which may not be the only prophylactic effect of vancomycin.…”

Safety of prophylactic intracameral moxifloxacin 0.5% ophthalmic solution in cataract surgery patients

“…Unfortunately, there is a dearth of data in the literature on the bioavailability of antibiotics after intraocular administration in humans. [32][33][34] Furthermore, the data in these studies are not entirely conclusive as a result of unavoidable limitations in aqueous humor sampling. Because of the small volume of aqueous, which prevents repeated extractions, these studies evaluated antibiotic concentrations in different patients at different times.…”

“…The actual half-drop in concentration, however, may be closer to 1 to 2 hours, as reported for irrigation fluid antibiotics. [32][33][34] If these data reflect actual circumstances and if presumed constant elimination rates based on available information are to be believed (T.P. O'Brien, MD, ''Vigamox Protects Against Staph Isolates in Cataract Surgery Patients,'' EyeWorld, October 2005, 10[suppl]), moxifloxacin levels in the aqueous exceeding MICs for relevant species will persist for a conservatively estimated time of 5 hours.…”