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  • Title: Role of topical fluoroquinolones on the pathogenesis of diffuse lamellar keratitis in experimental in vivo studies.
    Author: Mah FS, Romanowski EG, Dhaliwal DK, Yates KA, Gordon YJ.
    Journal: J Cataract Refract Surg; 2006 Feb; 32(2):264-8. PubMed ID: 16565003.
    Abstract:
    PURPOSE: To investigate the potential role of commercially available topical fluoroquinolones in diffuse lamellar keratitis (DLK) using New Zealand White rabbit models. SETTING: Campbell Ophthalmic Microbiology Laboratory at the University of Pittsburgh, Pittsburgh, Pennsylvania, USA. METHODS: In a DLK challenge model, laser in situ keratomileusis flaps were created by a microkeratome in rabbit eyes (n = 10 per group) and the stromal beds were treated with 1 drop of Ciloxan (ciprofloxacin 0.3%), Ocuflox (ofloxacin 0.3%), balanced salt solution (BSS), or Pseudomonas aeruginosa endotoxin before flap closure. After the procedure, eyes were treated with the same drugs 4 times daily. On postoperative day 1, the eyes were examined by slitlamp and graded (modified Linebarger DLK grading scale) in a masked fashion. In a DLK exacerbation model, all eyes received 1 drop of endotoxin on the stromal interface followed by flap closure. After the procedure, the rabbit eyes (10 per group) were treated 4 times daily with Ciloxan, Ocuflox, or BSS and graded for DLK on postoperative day 1 as before. RESULTS: In the challenge model, Ciloxan, Ocuflox, and endotoxin all produced higher median DLK scores than the BSS control (P = .02). Ciloxan produced significant DLK in more eyes and had higher median scores (70%, 1.0) than Ocuflox (40%, 0.5) or endotoxin (45%, 0.5) (P = .05). In the endotoxin-induced model, Ciloxan produced significantly higher DLK scores than Ocuflox or BSS (P = .05). CONCLUSIONS: Topical fluoroquinolones caused and exacerbated DLK in rabbit models. Ocuflox was associated with less DLK than Ciloxan. The clinical significance of these findings can only be assessed in clinical trials.
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