Severe Corneal Toxicity After Topical Fluoroquinolone Therapy

Walter, Keith A.; Tyler, Marshall E.

doi:10.1097/01.ico.0000224642.43601.14

Cited by 34 publications

(20 citation statements)

References 2 publications

(2 reference statements)

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“…19,[21][22][23] The ocular and systemic safety profile of newer FQs is generally considered comparable with those of other FQ antimicrobial agents, with a low recognized risk of quinolone-related toxicity. [24][25][26][27] However, Walter et al 28 reported two cases of severe sterile corneal ulcers after the topical application of moxifloxacin, and the drug was suspected of interfering with corneal healing. Several factors may contribute to the cytotoxicity of FQ eye drops.…”

Section: Introductionmentioning

confidence: 99%

Comparison of fluoroquinolones: cytotoxicity on human corneal epithelial cells

Tsai

Chen

2009

Eye

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Purpose To compare the cytotoxicity of different fluoroquinolones (FQs) towards human corneal epithelial cells (HCECs). Methods HCECs were incubated with FQs (norfloxacin, ciprofloxacin, ofloxacin, levofloxacin, moxifloxacin, and gatifloxacin), both as commercial ophthalmic formulations and as unpreserved solutions. Cells incubated in different formulations of gentamicin, cefazolin, and benzalkonium chloride (BAC) were also compared. A cell viability assay, using 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assay, was used to evaluate the drug effects on cell viability after five incubation times (30 min, 1 h, 4 h, 8 h, and 24 h). Transepithelial electrical resistance (TEER) was measured with a voltohmmeter to help understand changes in paracellular permeability at five time points (4 h, 8 h, 12 h, 24 h, and 48 h). Cell morphology was observed with an inverted fluorescence microscope, with multiple stage position and in time-lapse mode. Results The preserving solutions and BAC at concentrations above 0.005% significantly decreased cell viability, when assayed by MTS. Increased paracellular permeability and decreased membrane integrity were also observed by TEER measurements and inverted fluorescence microscopy. Ofloxacin and levofloxacin were both free of preservatives and showed the least cytotoxicity towards HCECs in commercial FQ eye drops. Conclusions The cytotoxicity observed with FQ eye drops seems to be caused mainly by the preservative, which induced a significant decrease in membrane integrity and increased paracellular permeability. We found the new generation of FQs (moxifloxacin and gatifloxacin) no less cytotoxic towards HCECs than the old generation ones.

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Section: Introductionmentioning

confidence: 99%

Comparison of fluoroquinolones: cytotoxicity on human corneal epithelial cells

Tsai

Chen

2009

Eye

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“…There have also been two cases of sterile corneal ulcers after several weeks of therapy with topical moxifloxacin, but no similar cases have been reported for gatifloxacin [6].…”

Section: Safety and Tolerabilitymentioning

confidence: 96%

“…In the past, broad-spectrum intensive therapy with several fortified antimicrobials would usually be instituted until the culture results were available. Since their introduction in the 1990s, the usage of fluoroquinolones has gained widespread popularity [6][7][8][9][10]. However, over the past 10 years, fluoroquinolone resistance has become an increasing concern.…”

Section: Overview Of the Marketmentioning

confidence: 99%

Gatifloxacin ophthalmic solution 0.3% in the treatment of bacterial keratitis

Reznik¹,

Kim²,

Dekhayser³

et al. 2008

Expert Review of Ophthalmology

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Infectious keratitis can be a medical emergency that can lead to a profound loss of vision if not treated promptly and appropriately. Although a shift in the etiology and predisposing factors has been reported within the past few years, bacteria still predominate as the causative organisms of infectious keratitis in temperate climates. The clinical outcome is greatly influenced by the rate of epithelial and stromal healing, which is affected by multiple factors, including the overall health of the patient, status of the ocular surface and selection of the topical ophthalmic preparations used during treatment. Fourth-generation fluoroquinolones, including gatifloxacin, have been widely adopted for an 'off-label' treatment of bacterial keratitis because of their broad-spectrum potency and effective penetration, as well as their minimal effects on corneal wound healing.

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“…6 In patients with corneal disorders, however, they may delay healing. 7,8 These drugs have been reported to inhibit the proliferation of corneal cells in both a concentration-and time-dependent manner in vitro. [9][10][11][12] In this study, the authors examined the effects of 4 fluoroquinolone-based ophthalmic solutions, including highconcentration formulations, on the proliferative capacity of rabbit corneal cells in vitro and on rabbit corneal epithelial wound healing by using electrical corneal resistance (CR) measurements in vivo.…”

Section: Introductionmentioning

confidence: 99%