1. 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

2. 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

3. 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

4. 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.

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

6. 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

7. 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

8. Results

9. 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 ± ±
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

10. 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

11. 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.

12. ASCRS Thank you for your attention