Intracameral moxifloxacin: a safe option for endophthalmitis prophylaxis? In vitro safety profile for intraocular application

• Published in: Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft 2010-08, Vol.107 (8), p.720
• Main Authors: Kernt, M, Hirneiss, C, Neubauer, A S, Liegl, R G, Eibl, K H, Wolf, A, de Kaspar, H, Ulbig, M W, Kampik, A
• Format: Article
• Language: ger
• Subjects: Anterior Chamber; Anti-Infective Agents - administration & dosage; Anti-Infective Agents - toxicity; Aza Compounds - administration & dosage; Aza Compounds - toxicity; Cell Count; Cell Survival - drug effects; Cells, Cultured; Dose-Response Relationship, Drug; Endophthalmitis - immunology; Endophthalmitis - prevention & control; Endothelial Cells - drug effects; Endothelial Cells - immunology; Epithelium, Corneal - drug effects; Epithelium, Corneal - immunology; Fluoroquinolones; Humans; In Vitro Techniques; Inflammation Mediators - metabolism; Lens, Crystalline - drug effects; Lens, Crystalline - immunology; Lipopolysaccharides - immunology; Oxidative Stress - drug effects; Oxidative Stress - immunology; Pigment Epithelium of Eye - drug effects; Pigment Epithelium of Eye - immunology; Quinolines - administration & dosage; Quinolines - toxicity; Trabecular Meshwork - drug effects; Trabecular Meshwork - immunology
• ISSN: 1433-0423
• DOI: 10.1007/s00347-009-2027-9

Moxifloxacin (Vigamox), a 4th-generation fluoroquinolone, covers most isolates causing endophthalmitis. It is safe and effective for systemic and topical use; however, only very limited data are available on prophylactic intracameral administration to prevent endophthalmitis. This study investigated the safety of Vigamox for intracameral application in a cell-culture model. The endothelial toxicity of moxifloxacin (Vigamox) was evaluated in cultured human corneas. Primary human retinal pigment epithelium cells (RPEs), trabecular meshwork cells (TMCs), lens epithelium cells (LECs), and corneal endothelial cells (CECs) were treated with concentrations of Vigamox. Toxic effects were evaluated after 24 h (MTT assay and live-dead assay). By treating TMC, CEC, and RPE cells either with oxidative stress or tumor necrosis factor-alpha (TNF-a), lipopolysaccharide (LPS), and interleukin-6 (IL-6), the effects of moxifloxacin on cellular viability under conditions of inflammation were investigated. No corneal endothelial toxicity could be detected after 30 days of treatment with moxifloxacin 500 microg/ml. Primary RPEs, TMCs, LECs, and CECs showed adverse effects on proliferation and viability only at concentrations higher than 150 microg/ml moxifloxacin. After preincubation with TNF-a, LPS, and IL-6 for 24 h and subsequent treatment with moxifloxacin at concentrations of 10-150 microg/ml for 24 h, no significant decrease in proliferation or viability was observed. H2O2 exposure did not increase cellular toxicity Vigamox did not show significant toxicity on primary RPEs, TMCs, LECs, CECs, or human corneal endothelium at concentrations up to 150 microg/ml. The MIC90 of moxifloxacin for pathogens commonly encountered in endophthalmitis is known to be in the range of 0.25-2.5 microg/ml. Therefore, intracameral use of Vigamox at concentrations up to 150 microg/ml may be safe and effective for preventing endophthalmitis after intraocular surgery.