Abstract

Volume.123 Number.4

Original article : Clinical science

Effecacy of Antibacterial Eye Drops in Patients Undergoing Intravitreal Injection Therapy Using Anti-Vascular Endothelial Growth Factor Drug
Yoshihiro Wakabayashi1, Shigeto Kumakura1, Setsuko Kawakami1, Daisuke Muramatsu1, Kazuhiko Umazume1, Kaori Yamamoto1, Rei Nemoto1, Shun-ichiro Ueda1, Yoko Watanabe1, Yoshihiro Sugio2, Hiroshi Goto1
1 Department of Ophthalmology, Tokyo Medical University
2 Santen Pharmaceutical Co., Ltd.

Purpose: To compare the efficacy of antibacterial eye-drop monotherapy for reducing bacterial concentration in patients undergoing intravenous anti-vascular endothelial growth factor (VEGF) intravitreal injection therapy with that of antibiotic cycling therapy.
Subjects and methods: The subjects included 38 patients (38 eyes) who underwent introductory-phase anti-VEGF therapy on 3 consecutive times per month after being examined for macular edema caused by age-related macular degeneration (AMD) or retinal vein occlusion (RVO) between June 2014 and October 2016. Eye drops were administered before and after each intravitreal injection for a total of 3 days of administration. The subjects were randomly allotted to either the group that received repeated monotherapy of 1.5% levofloxacin (LVFX) eye drops (LVFX monotherapy group) or the group that received either LVFX or cefmenoxime (CMX) alternatively at each intravitreal injection (cycling-therapy group). Conjunctival scrapings collected before and after pre-injection eye-drop administration were cultured, and the minimum inhibitory concentration (MIC) of the major naturally-occurring bacteria Staphylococcus epidermidis (S. epidermidis) was investigated.
Results: Sterilization rates after eye-drop administration prior to the initial and third injections were 75.0% and 53.8% in the LVFX monotherapy group and 72.7% and 72.7% in the cycling-therapy group, respectively; however, no statistically significant differences were noted between the two groups. At the examination before eye-drop administration prior to the initial injection and that before eye-drop administration prior to the 4th injection following the introductory phase, the mean MIC and 95% confidence interval for LVFX against S. epidermidis changed from 0.56 (95% CI, lower limit - upper limit: 0.11-3.00) to 28.02 (5.91-132.89) μg/mL in the LVFX monotherapy group and from 0.51 (0.06-4.01) to 10.56 (1.68-66.53) μg/mL in the cycling-therapy group. Although both groups showed significant increases in MIC, no statistically significant differences were noted between the groups.
Conclusion: While administration antibacterial eye drops during anti-VEGF therapy, attention should be paid to increases in bacterial concentration with low drug sensitivity.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 123: 395-401, 2019.

Key words
Intravitreal injection, Antibacterial eye drops, Preoperative sterilization, Minimum inhibitory concentration (MIC)
Reprint requests to
Yoshihiro Wakabayashi, M.D. Department of Ophthalmology, Tokyo Medical University. 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan