Neither of authors has a financial or proprietary interest in any material or method mentioned. ASCRS Comparison of the effects of fourth-generation fluoroquinolones on epithelial healing after PRK Department of Ophthalmology College of Hallym University Hallym Medical Center Seoul, South Korea Jung Hwan Shin MD Ha Bum Lee MD Hye Young Park MD

Introduction Fluoroquinolones, with excellent broad-spectrum coverage and good ocular tolerance, have been frequently used as prophylactic agents both for traumatic corneal erosions and in refractive surgery. Fourth Generation Third Generation Second Generation Moxifloxacin Gatifloxacin Grepafloxacin Levofloxacin Ciprofloxacin Lomefloxacin Norfloxacin Ofloxacin

4th generation fluoroquinolones advantage Introduction Broad spectrum of activity - more susceptible of gram-positive orginism Atypical mycobacteria coverage Good ocular penetration Improved penetration into ant. chamber 4th generation fluoroquinolones advantage Better MIC90 (minimum inhibitory concentration 90s) Less resistance BUT, may inhibit corneal wound healing

Introduction One study showed Comparison of Zymar and Vigamox on clinical setting(post PRK)  Their study suggests that Vigamox has a more favorable epithelial healing profile in a post PRK But, because of Zymar is contained BAK, it is not a same condition.

Purpose To compare the effects on epithelial healing of gatifloxacin and moxifloxacin used for antimicrobial prophylaxis following photorefractive keratectomy (PRK) Preservative-free Preservative-free

Subjects and methods Design Subject Method Outcome MEL80 Double-masked randomized prospective trial Subject Forty-four patients undergoing PRK(photorefractive keratectomy) with 7mm epithelial defect Method Received gatifloxacin(Gatiflo® 0.3%, no preservative) in one eye and moxifloxacin(Vigamox® 0.5%, no preservative) in fellow eye for prophylactic antibiotics MEL80 Mean epithelial healing time Mean defect size Pain score Outcome

Subjects and methods Ex. Data analysis Defect calculation (pixels) POD #1 POD #2 OD Gatiflo® OS Vigamox® POD #3 28164 pixels 25793 pixels 4371 pixels 2017 pixels 0 pixels Ex. Defect calculation (pixels) :using Adobe photoshop CS3 Data analysis Mann-Whitney U test SPSS 12.0 (SPSS Inc., USA) p value < 0.05

Results

Mean defect size(pixels) Results [Table 1] The mean epithelial healing time and mean defect size Gatiflo® Vigamox® P-value† Healing time(d) 2.97±0.41 2.95±0.48 0.810 Mean defect size(pixels) POD#1 43200.2±11475.8 40303.6±11211.6 0.327 POD#2 6959.4±8325.3 5988.1±7616.3 0.578 POD#3 205.9±1026.7 333.1±1265.2 0.606 † Mann-whitney U test POD: postoperative day No significant difference in the effects of fourth-generation fluoroquinolones

Results [Table 2] Vision(VA & BCVA) of POD #90 and pain score Gatiflo® Vigamox® P-value† VA(logMAR) -0.036±0.081 -0.064±0.051 0.562 BCVA(logMAR) -0.091±0.054 -0.082±0.060 0.748 Pain score(0~4) POD#1 2.64±0.78 2.95±0.69 0.438 POD#2 1.73±0.90 1.000 POD#3 0.45±0.52 0.68±0.56 0.401 † Mann-whitney U test VA : visual acuity, BCVA : best corrective visual acuity Pain score(0~4) 0 no pain         1     mild             2     discomforting(burning sense)   3     distressing(need analgesic)     4     excruciating(not subside despite analgesic)     No significant difference in the effects of fourth-generation fluoroquinolones

Discussion This study demonstrated that the commercial ophthalmic formulations of moxifloxacin(Vigamox®) and gatifloxacin(Gatiflo®) were similar to each other in their effects on rates of corneal wound re-epithelialization. This result carries an important meaning because both eye drops we used are preservative-free.

ASCRS Thank you for your attention