Topical Ofloxacin Research Articles

Efficacy of Topical Ofloxacin 0.3 % Administration on Conjunctival Bacterial Flora in Diabetic Patients Undergoing Intravitreal Injections

ABSTRACTPurpose: This prospective, randomized case series study aims to evaluate the efficacy of ofloxacin 0.3% eye drops in eradication of conjunctival bacterial flora in diabetic patients undergoing intravitreal injections (IVI). Methods: Ninety-two diabetic patients (92 eyes) scheduled to undergo intravitreal injection of ranibizumab due to diabetic macular edema were enrolled in the study. Patients were randomly assigned to three different groups. Group 1 (n=32) received ofloxacin eye drops the day before before IVI (four times); patients in Group 2 (n=29) were administered ofloxacin one hour before IVI (every 15 minutes), while Group 3 (n=31) comprised patients that received combined administration of ofloxacin both one day and one hour before IVI (eight doses). Samples were collected from the injection site before and after antibiotic administration. Culture results from BACTEC broth and positive cultures in blood agar and Sabouraud’s dextrose agar plates were measured. Results: In Group 1, BACTEC broth positive cultures decreased from 84.4% at baseline to 50% after ofloxacin administration (p=0.007), and blood agar positive cultures reduced from 65.63% to 34.38% (p=0.02). In Group 2, positive cultures significantly decreased in BACTEC broth (from 79.3% at baseline to 48.28%; p=0.027) and in blood agar (from 68.97% to 37.13%; p=0.034). In Group 3, positive cultures decreased from 77.42% at baseline to 32.26% (p=0.0008) and from 58.06% at baseline to 22.58% (p=0.009) in BACTEC broth and blood agar, respectively. No microorganisms were isolated from Sabouraud’s dextrose agar plates. Conclusions: The combined one day/one hour (eight doses) ofloxacin administration in diabetic patients is extremely effective in reducing conjunctival bacterial flora. The application of topical ofloxacin for one day or one hour before IVI is also significantly effective.

Chronic Recurrent Pseudophakic Endophthalmitis

An immunocompetentwoman in her 80s underwent uncomplicated cataract surgery in her righteye4monthspriorwithbest-correctedvisualacuity (BCVA)of20/25OD.Twoweeks prior topresentation, shereportedagradual increase inblurredvisionwith intermittent floaters in the right eyebut deniedpain or inciting events.HerBCVAwas20/50OD. Therewere large keratic precipitates, 1+ anterior chamber cell and flare, and no hypopyon. Numerous white precipitates were noted on the anterior and posterior surface of a 3-piece posterior chamber intraocular lens (Figure, A). Therewere 2+ to 3+ anterior vitreous cells and a 2–disc area chorioretinal scar along the superior retinal arcadeswith extramacular drusen, but no areasof chorioretinitis (Figure, B). B-scanultrasonography showedaposterior vitreousdetachmentandmoderatevitreousopacities.Thecontralateralphakiceyeshowedsimilardrusen but was otherwise unremarkable. The patient underwent a vitreous tap,whichwas negative for organisms, aswell as injection of intravitreal vancomycin hydrochloride and ceftazidime in the right eye. Topical prednisolone acetate and ofloxacin were started 4 times daily, and steroids were increased toevery2hourswhile awakeat follow-up.HerBCVA improved to20/30OD4days later. TheBCVAremainedexcellent andkeraticprecipitatesdissipatedby 1monthof followup, with stable findings in the posterior pole. Topical antibiotics were stopped and topical steroidswere gradually tapered. At 2months’ follow-up, however, she had recurrent anterior chamber and vitreous inflammation with mild cystoid macular edema. Quiz at jamaophthalmology.com Fundus photograph B Slitlamp photograph A

Comparative Effectiveness of Antibiotic Prophylaxis in Cataract Surgery

Intracameral injection is an effective method for preventing infection, but no controlled study has been published in the United States. We conducted an observational, longitudinal cohort study to examine the effect of topical and injected antibiotics on risk of endophthalmitis. We identified 315 246 eligible cataract procedures in 204 515 members of Kaiser Permanente, California, 2005-2012. The study used information from the membership, medical, pharmacy, and surgical records from the electronic health record. The adjusted odds ratio (OR) and 95% confidence interval (CI) for the association of antibiotic prophylaxis (route and agent) with risk of endophthalmitis was estimated using logistic regression analysis. We confirmed 215 cases of endophthalmitis (0.07% or 0.7/1000). Posterior capsular rupture was associated with a 3.68-fold increased risk of endophthalmitis (CI, 1.89-7.20). Intracameral antibiotic was more effective than topical agent alone (OR, 0.58; CI, 0.38-0.91). Combining topical gatifloxacin or ofloxacin with intracameral agent was not more effective than using an intracameral agent alone (compared with intracameral only: intracameral plus topical, OR, 1.63; CI, 0.48-5.47). Compared with topical gatifloxacin, prophylaxis using topical aminoglycoside was ineffective (OR, 1.97; CI, 1.17-3.31). Surgical complication remains a key risk factor for endophthalmitis. Intracameral antibiotic was more effective for preventing post-cataract extraction endophthalmitis than topical antibiotic alone. Topical antibiotic was not shown to add to the effectiveness of an intracameral regimen.

Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery: Results of the 2014 ASCRS member survey

A 2014 online survey of the American Society of Cataract and Refractive Surgery members indicated increasing use of intracameral antibiotic injection prophylaxis compared with a comparable survey from 2007. Forty-seven percent of respondents already used or planned to adopt this measure. One half of all surgeons not using intracameral prophylaxis expressed concern about the risks of noncommercially prepared antibiotic preparations. Overall, the large majority (75%) said they believe it is important to have a commercially available antibiotic approved for intracameral injection. Assuming reasonable cost, the survey indicates that commercial availability of Aprokam (cefuroxime) would increase the overall percentage of surgeons using intracameral antibiotic injection prophylaxis to nearly 84%. Although the majority used topical perioperative antibiotic prophylaxis, and gatifloxacin and moxifloxacin were still the most popular agents, there was a trend toward declining use of fourth-generation fluoroquinolones (60%, down from 81% in 2007) and greater use of topical ofloxacin and ciprofloxacin (21%, up from 9% in 2007).

Effectiveness of Topical Ofloxacin Ointment for Genitourinary Post-Operative Patients with Urinary Catheterization

Purpose: Catheter associated urinary tract infection and discomfort is common in patients with an indwelling urinary catheter. We investigated the effectiveness of prophylactic topical antibiotic ointment for genitourinary post-operative patients with a urinary catheter. Materials and Methods: We investigated 112 inpatients between March 2013 and October 2013, who had an indwelling urinary catheter ≥24 hours after a genitourinary operation in our institution from medical records. Among 112 patients, 59 patients applied ofloxacin ointment to urethral meatus around the indwelling catheter twice a day (ointment group: 52.7%) and 53 patients did not (non-ointment group: 47.3%). All patients were examined by urine analysis and urine culture before the operation, urethral sweep culture after catheter removal, and severity of pain was recorded as visual analogue scale (VAS) score while having an indwelling urinary catheter. Results: Mean duration of urinary catheter of both groups did not differ statistically (3.08±2.19 day, 2.91±2.25 day). Patients with pyuria detected at pre-operative urinalysis were 22.1% vs. 15.1%, pre-operative urine culture positive were 6.8% vs. 9.4%, urethra meatal culture positive after urethral catheter removal were 16.9% vs. 13.2%, respectively, and all results showed no significant differences between two groups. VAS scores of the ointment group (3.52±1.66) while having an indwelling urinary catheter were significantly lower than those of the non-ointment group (5.61±1.75) (p<0.001). Conclusions: Application of topical antibiotic ointment for genitourinary post-operative patients with urinary catheter had no benefit in reducing growth of urethral microorganisms, but it may decrease pain from an indwelling urinary catheter.

Effect of topical ofloxacin on bacterial biofilms in refractory post-sinus surgery rhino-sinusitis.

Bacterial biofilms have been shown to play a major role in many chronic infections, in addition, there is growing evidence that bacterial biofilms may play a role in some forms of refractory CRS that persists despite proper surgery and culture directed antibiotic therapy. The objective is to determine the effect of application of topical ofloxacin on nasal and sinus mucosa in patients with proven existence of bacterial biofilms and persistent chronic sinusitis after FESS. The study design is a prospective controlled study. The study included a total of 12 patients who had refractory CRS in spite of undergoing FESS for that specific reason (study group), and control group (involved 25 patients), for whom FESS was done, with complete improvement postoperatively in 15 of them, and persistence of symptoms in the other ten. Topical ofloxacin eye drops (0.3 %) tds for 12 weeks were prescribed for (study group), culture and sensitivity and scanning electron microscopy were done for middle meatal mucosal specimens for all patients and controls, all of them were followed up for a minimum of 9 months (range 9-18 months). Of the study group, 80 % showed marked improvement in the structure of the mucosa, with the regaining of normal respiratory epithelium, with complete disappearance of the biofilm surface, and the remaining 20 % showed only reduction in the number of inflammatory cells and regaining cilia with scattered patches of very thin biofilm. Biofilms formation plays an active role in perpetuating inflammation in CRS patients and enhanced the recurrence and resistance in those patients, we found a statistically significant improvement in patients' group (P < 0.001), after 12 weeks of topical ofloxacin (without any evidence of any side effects). So, we concluded that topical ofloxacin seems to be an effective, tolerable, convenient, cheap and even safe mode of treatment of refractory CRS after FESS due to biofilms' formation. Thus, we recommend such modality of treatment postoperatively especially in refractory cases of CRS.

Impact of Antibiotic Prophylaxis on the Conjunctival Flora of Patients Receiving Intravitreal Antivascular Endothelial Growth Factor Injections

Purpose: To characterize the conjunctival flora of patients receiving antibiotics before intravitreal (IVT) antivascular endothelial growth factor injections. Methods: We studied 31 eyes of 30 patients with neovascular age-related macular degeneration scheduled to receive IVT antivascular endothelial growth factor injections. The patients were all given a preinjection of topical ofloxacin 3 days before the injections. Conjunctival cultures from the injection eye were collected before antibiotic prophylaxis (sample A) and on the injection day, both before (sample B) and after (sample C) povidone-iodine (PVI) application. Results: Culture positivity was significantly different between samples A (50%) and C (4.5%; p < 0.001) as well as samples B (30.4%) and C (4.5%; p = 0.015), but not between samples A and B. Positive cultures were mainly coagulase-negative staphylococci (CNS; 57% of sample A, 62.5% of sample B and 100% of sample C) susceptible to vancomycin (100%), moxifloxacin (90%), levofloxacin (70%) and ofloxacin (60%). Conclusion: In our study, most of the bacteria isolated were CNS. PVI application but not antibiotics reduced culture positivity.

Analysis of conjunctival bacterial flora in the preparation of patients for cataract surgery

In most cases, microorganisms responsible for intraocular infection are identical to the organisms on the ocular surface of the patient's ocular adnexa. The preoperative and postoperative infection prophylaxis aims to reduce the risk of infection from bacterial flora of the eye and adnexa and to eliminate bacteria that can contaminate the wound during surgery. The aim of our study was the microbiological analysis of the bacterial flora of the conjunctiva, preoperative eradication in terms of prophylaxis of endophthalmitis following cataract surgery and to determine the effectiveness of ofloxacin 0.3 % in bacteria reduction. The study included 120 patients suffering from senile cataract selected at the Department of Ophthalmology, Clinical Centre Niš, divided into two groups of 60 patients. The control group of 60 patients did not receive antibiotics preoperatively. The second group of 60 patients was treated topically with ofloxacin 0.3% in the form of drops, four times a day for four days prior to surgery, and four times for two hours prior to surgery. Examination of the conjunctival flora was carried out using standard microbiological procedures. The conjunctival swabs were collected from all patients at the time of the selection for surgery (the first swab), four days prior to surgery (second swab) and immediately before the operation and on entering the operating room (third swab). In the control group of patients, the first and second conjunctival swabs were positive in 9 and negative in 51 patients. The third swab findings did not change (9 positive and 51 negative swabs). There was no statistically significant difference between the findings of the first, second and third swabs of patients in the control group (χ2 test, p>0.05). In the therapy group of patients, the first and second conjunctival swabs were positive in 6 cases and negative in 54 patients. Detection of the third sample from this group was sterile in all 60 patients. There was a statistically significant difference between the findings of the second and third swabs of patients in the treatment group, ie. there was a correlation between the response to therapy and the outcome of patients (χ2 test, p<0,05). Among the 15 positive conjunctival swab findings the most common cause of infection were Staphylococcus aureus (6 swabs) and Staphylococcus epidermidis (5 swabs), Enterobacter spp. (2 swabs), Proteus mirabilis and Pseudomonas aeruginosa in one swab respectively. Topical ofloxacin 0.3 % for four days prior to surgery, and four times in two hours before the operation is effective in the elimination of the bacterial flora of the conjunctiva and the sterility is achieved in all cases.

A case of antibacterial‐responsive mucocutaneous disease in a seven‐year‐old dwarf lop rabbit (Oryctolagus cuniculus) resembling mucocutaneous pyoderma of dogs

A seven-year-old, ovariohysterectomised female dwarf lop rabbit (Oryctolagus cuniculus) was referred with severe swelling and erythema of the mucocutaneous junctions of the lips, nares and vulva. Bilateral, severe periocular dermatitis was also present. Heavy pure growths of a member of the Staphylococcus intermedius group were cultured from nasal and aural swabs and skin biopsies. Other possible differential diagnoses were eliminated by standard tests. The clinical features and histopathological characteristics of the biopsies were most consistent with mucocutaneous pyoderma, a dermatosis previously reported in dogs but not in rabbits. Treatment of the bacterial infection with oral marbofloxacin and topical ofloxacin eye drops together with supportive therapy resulted in resolution of the lesions. To the authors' knowledge, this is the first report of mucocutaneous bacterial pyoderma, similar to mucocutaneous pyoderma of dogs, in a rabbit.

Topical azithromycin or ofloxacin for endophthalmitis

Topical azithromycin or ofloxacin for endophthalmitis Michael W Stewart, Michael L StewartDepartment of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA The recently published study by Romero-Aroca et al1 raises interesting questions regarding the effect of choice of topical antibiotic (azithromycin versus ofloxacin) on the incidence of endophthalmitis following intravitreal injections. However, important conclusions advanced by the authors deserve further discussion. First, the authors state that use of azithromycin leads to significantly fewer cases of post-injection endophthalmitis than does the use of ofloxacin. Their prospective series shows a lower endophthalmitis rate in eyes treated with azithromycin (two cases in 4045 injections, 0.049%) than in eyes treated with ofloxacin (five cases in 4151 injections, 0.12%). They calculate a relative risk of 2.37, and conclude that this was statistically significant (confidence interval 1.37–3.72; P < 0.001).View original paper by Romero-Aroca and colleagues.

Methicillin‐resistant Staphylococcus aureus keratitis in a dog

The purpose of this study is to report a case of methicillin-resistant Staphylococcus aureus (MRSA) keratitis in a dog. A 7-year-old intact male American cocker spaniel that had undergone removal of a nictitating gland was referred for severe ulcerative keratitis. Slit-lamp examination showed swelling of the eyelid, mucopurulent discharge, conjunctival injection and chemosis, diffuse corneal edema and opacity, and a deep ulcer in central cornea. Gram staining of discharge from the eye demonstrated Gram-positive cocci. Despite topical ofloxacin, oxytetracycline and polymyxin B ophthalmic solution and intravenous cefazolin, there was no improvement. Cultures revealed MRSA that was sensitive only to chloramphenicol, vancomycin, lincomycin, and clindamycin. The antibiotic regimen was changed to topical and systemic chloramphenicol. After 9 days of treatment, although inflammation started to be resolved, the dog developed nonregenerative anemia. The antimicrobial regimen was changed again to topical and systemic vancomycin. Inflammation continued to improve over the next week. MRSA should be considered a potential organism in infectious keratitis, especially when general antibiotics are not effective. Although topical and systemic chloramphenicol and/or vancomycin are effective for treating MRSA keratitis, vancomycin should only be used when culture and susceptibility results indicate it is appropriate and no other options are available. To our knowledge, this is the first detailed case report of MRSA keratitis in a dog.

The Comparison of Fluoroquinolones to Nonfluoroquinolone Antibacterial Agents for the Prevention of Endophthalmitis in a Rabbit Model

Topical antibacterial agents, used as an off-label indication, are frequently administered pre- and postoperatively to prevent endophthalmitis. We compared topical treatment with fluoroquinolone (FQ) anti-infectives to non-FQ antibacterial agents to prevent Staphylococcus aureus endophthalmitis. We hypothesize that FQ anti-infectives are more effective than non-FQ antibacterial agents for preventing endophthalmitis. Moxifloxacin 0.5%, ofloxacin 0.3%, gentamicin 0.3%, chloramphenicol 0.5%, polymyxin B/trimethoprim (10,000 units/mL/0.1%), povidone-iodine 5%, and saline were tested for topical treatment to prevent endophthalmitis. Topical treatment was applied every 15 min for 1 h (5 drops) to the left eye of 14 rabbits for each antibacterial agent and saline. After appropriate anesthesia, the anterior chambers were injected with 1×10(5) colony-forming units of a clinical endophthalmitis isolate of a S. aureus that was susceptible to all tested antibacterials. One drop was administered immediately and another 4 drops of topical treatment were applied over 24 h after injection. At 24 h postinjection, the eyes were graded for clinical signs of endophthalmitis (ocular discharge, conjunctivitis/scleral injection, limbal injection, hypopyon*, iritis*, anterior chamber cells*, anterior chamber flare*, corneal infiltration, and fibrin production*) using a severity scale (0-3). The indication of clinical endophthalmitis was a total score of >3.0 for the presentations marked with an asterisk. The data were analyzed using Fisher's Exact Randomization or Mann-Whitney nonparametric testing. Topical ofloxacin (14/14, 100% without endophthalmitis) and moxifloxacin (13/14, 93%) prevented the clinical presentation of endophthalmitis significantly more frequently (P=0.03, Fisher's Exact Test (FE)) than topical gentamicin (7/14, 50%), povidone iodine (4/14, 29%), chloramphenicol (0/14, 0%), polymyxin B/trimethoprim (0/14, 0%), and saline (0/14, 0%). The median total clinical scores for the ofloxacin (0.5) and moxifloxacin (0.8) groups were significantly (P=0.008, Mann-Whitney Test (MW)) lower than gentamicin (5.7), chloramphenicol (17.5), polymyxin B/trimethoprim (21.2), povidone-iodine (15.5), and saline (18.7). The FQs, ofloxacin and moxifloxacin, were more effective in preventing endophthalmitis than the non-FQ antibacterial agents in a rabbit S. aureus endophthalmitis model. The observed results are consistent with the hypothesis that FQs penetrate into the anterior chamber at more effective levels than many of the common non-FQ antibacterial agents.

Frog saliva-induced toxic keratopathy: a case report

Corneal toxicity due to exposure to many chemicals and medications have been described in the literature. We present a case of toxic keratopathy by corneal exposure to salivary secretion of a frog. A 40-year-old male patient reported a sudden splash of frog saliva in his right eye while he was examining it at a close distance. Corneal punctate epitheliopathy and stromal oedema and Descemet folds were the initial clinical findings, which completely recovered on the 2nd control day of topical dexamethasone and ofloxacin treatment. We aimed to show the toxic effects of animal-derived secretions on the cornea as a rare cause of toxic keratopathy.

Comparison of different techniques of cataract surgery in bacterial contamination of the anterior chamber in diabetic and non-diabetic population

Aim:To compare the bacterial contamination of the anterior chamber (AC) between manual small incision cataract surgery (SICS) and phacoemulsification (Phaco). To study the conjunctival flora and bacterial contamination of AC between well-controlled diabetics and non-diabetics.Materials and Methods:Three hundred and sixty-eight patients were randomized to manual SICS and Phaco. Sixty-eight patients were excluded for not completing follow-up or for intraoperative complications like posterior capsule rupture. One hundred and fifty patients in each group were finally analyzed. Conjunctival swabs were taken on admission, after one day of topical ofloxacin and 15 min after 5% Povidone Iodine (PI) instillation. AC aspirate at the end of the surgery was also cultured.Results:Fifty-six (18.66%) patients had positive conjunctival swab on admission which was reduced to 19 (6.33%) with topical ofloxacin and to five (1.66%) with instillation of 5% PI. AC contamination in both manual SICS and Phaco was 0.66%. The conjunctival flora in diabetics was similar to non-diabetics. None of the diabetics had AC contamination. Statistical analysis was performed by Chi-Square test (with Yates’ correction).Conclusion:Statistically significant reduction in conjunctival flora was achieved with topical ofloxacin and 5% PI instillation and AC contamination in both manual SICS and Phaco was minimal (0.66%). Well-controlled diabetics who underwent cataract surgery in this study had similar conjunctival flora and AC contamination as non-diabetics.

Reconstruction of corneal stroma with decellularized porcine xenografts in a rabbit model

To evaluate the potential use of decellularized porcine stromal matrix (PSM) for reconstruction of corneal stroma in a rabbit model. Ten chinchilla bastard rabbit corneas were exposed to a circular half-thickness keratotomy with a 3.0 mm diameter at the central cornea. Porcine corneas were decellularized using hypotonic tris buffer, ethylene diamine tetra-acetic acid (EDTA, 0.1%), aprotinin (10 K IU/ml) and 0.3% sodium dodecyl sulphate (SDS). The 3.0 mm in diameter decellularized corneal stromal xenograft was inserted into the pocket, and the incision was closed with four 10.0 nylon sutures. Clinical photographs were taken at day 1, day 7, day 30 and on a monthly basis for up to 6 months after transplantation. Six months after surgery, the rabbits were killed and eyes were enucleated. Haematoxylin-eosin (HE) and 4,6-diamidino-2-phenylindole (DAPI) staining were performed to confirm the complete removal of the corneal cells after decellularization of porcine corneas and repopulation with rabbit cells. Alcian blue staining was performed for analysing the structure of the extracellular matrix (ECM). Efficient elimination of porcine cells was achieved by our decellularization protocol and confirmed via HE and DAPI stainings. Moreover, the major histoarchitectural ECM structure had been maintained as visualized by the alcian blue stain. Finally, the PSM was biocompatible with the host's epithelium evidenced as a regrowth covering the exposed xenograft. This novel technique of tissue engineering may provide one of many solutions to addressing anterior corneal pathological conditions in the face of a shortage of human corneal material.

Post-operative ocular infection due to Streptococcus dysgalactiae subspecies equisimilis

Ocular infections due to Streptococcus dysgalactiae subsp. equisimilis are rare. In the present report, three patients with a history of uncomplicated small incision cataract surgery with intraocular lens implantation developed exogenous endophthalmitis due to Streptococcus dysgalactiae subsp. equisimilis. The identification of the organisms was confirmed by PCR for a 16S rRNA sequence specific to the species S. dysgalactiae. Intravitreal treatment of cefazolin and amikacin, in addition to topical ofloxacin and tobramycin, resulted in resolution of infection in all three patients. Our reports indicate the importance of bacterial culture and molecular identification in the diagnosis of S. dysgalactiae subsp. equisimilis infection in the eye.

Evaluation of Efficacy of Topical Povidone-Iodine and Different Types of Fluoroquinolones in the Sterilization of Bacterial Flora on the Conjunctiva

To compare the sterilization effectivity of topical povidone-iodine, ciprofloxacin, and ofloxacin on the conjunctival bacterial flora. One hundred sixty-four eyes of 164 patients scheduled for cataract surgery were prospectively analyzed. Conjunctival cultures were obtained 1 day before the surgery without any topical application in all patients. Conjunctival flora was examined in 53 eyes of 53 patients (Group I) 15 min after 5% topical povidone-iodine application on the day of the surgery. Fifty-four eyes of 54 patients (Group II) received 1 drop 0.3% ciprofloxacin at 12 pm 1 day before the operation and 4 drops at 15 min intervals on the day of the surgery. Another 57 eyes of 57 patients (Group III) received 0.3% ofloxacin in the same application mode as ciprofloxacin. Conjunctival cultures were taken in all patients 15 min after last drop of topical antibiotic application. Only coagulase-negative staphylococci were isolated from 75.4% in Group I, 72.2% in Group II, and 59.6% in Group III on pretreatment culture. Different types of bacteria such as Staphylococcus aureus, Bacillus subtilis, Escherichia coli, Proteus spp., Micrococcus spp. were identified in other patients. Pretreatment conjunctival flora of Group I and Group II were similar (P>0.05), but it was significantly different in Group III (P<0.05). After topical application no bacterial growth was observed in 77.3% in Group I, 92.5% in Group II, and 66.6% in Group III. The difference between Group I and III was insignificant (P>0.05), but bacterial eradication effectiveness was significantly higher in Group II than that of other groups (P<0.05). Post-treatment cultures showed same bacterial flora as pretreatment cultures in 14.9% in Group I, 1.8% in Group II, and 19.2% in Group III. The difference between Group I and Group III was statistically insignificant (P>0.05) and the difference between Group II and other groups was statistically significant (P<0.05). Four eyes (7.5%) showed different types of bacterial growth from pretreatment flora in Group I, which were seen in 3 eyes (5.5%) in Group II and in 8 eyes (14%) in Group III. The differences between groups were statistically insignificant (P>0.05). Ciprofloxacin seems to be more effective in conjunctival sterilization. In consideration with high variety of bacterial flora in pretreatment period in ofloxacin group, ofloxacin seems to be superior to povidone-iodine on the reduction of bacterial flora on the conjunctiva.

Unusual Presentation of Phacolytic Glaucoma: Simulating Microbial Keratitis

The differential diagnoses for phacolytic glaucoma are acute angle closure glaucoma, open angle glaucoma with uveitis, neovascular glaucoma, and glaucoma secondary to trauma. We report an unusual case where the dislocated cataractous lens firmly adherent to the corneal endothelium evoked a cellular reaction similar to phacolytic glaucoma but clinically appeared like a deep corneal abscess. The 73-year-old lady presented with severe photophobia, pain, and redness in the left eye for two months despite being on antibiotics and antifungals. Anterior chamber wash revealed a cataractous lens buried within the infiltrate, which was removed and sent for histopathological examination. Postoperatively she was treated with topical ofloxacin, homatropine, dorzolamide, timolol, and tapering dose of steroids. Histological confirmation of inflammation, histiocytic response, and giant cells around the lens material confirmed the ongoing phacolytic process. Photophobia, pain, and redness subsided following removal of the lens and surrounding cellular reaction. At her last visit, four months after surgery, she was comfortable.

Bulbar Conjunctival Sporotrichosis Presenting as a Salmon-Pink Tumor

To report a patient with bulbar conjunctival sporotrichosis presenting as a salmon-pink tumor. This was an interventional case report. A 62-year-old woman presented with conjunctival injection in her left eye. Despite administration of topical dexamethasone sodium, ofloxacin, and levocabastine hydrochloride, her symptoms failed to improve and she was referred to us. Four weeks after referral to us, the patient gradually developed conjunctival injection in both eyes and a salmon-pink tumor in the bulbar conjunctiva of the left eye. Excision biopsy was performed and pathologic examination revealed an epithelioid granuloma with microabscesses and infiltration of plasma cells with yeast-like spherules. A sporotrichin intradermal test was strongly positive. Based on a diagnosis of sporotrichosis, we treated her with topical fluconazole 0.2% in both eyes and oral potassium iodide (450 mg). The bilateral conjunctival injection and subconjunctival tumor in the left eye gradually resolved and had completely disappeared after 3 months of treatment. This is the first report of bulbar conjunctival sporotrichosis with a salmon-pink conjunctival tumor. Although rare, ophthalmologists should be aware of this entity during examination of patients with intractable conjunctival injection.

Successful Use of Topical Voriconazole 1% Alone as First-Line Antifungal Therapy Against Candida albicans Keratitis

Objective: To report the successful use of topical voriconazole 1% given alone as primary therapy against a case of Candida albicans keratitis. Case Summary: A 48-year-old previously well man presented to the emergency department with pain and foreign body sensation in the left eye following exposure to dust while driving a forklift He wore weekly disposable soft contact lenses. Anterior stromal scar and dense infiltrate were detected in the left eye. The anterior chamber remained deep, with flare and copious white cells. Intraocular pressure was 12 mm Hg and visual acuity was 20/200. The epithelial defect persisted, with progressive thinning despite topical fluorometholone and ofloxacin 0.3% therapy for 2 days. Microbiology testing revealed C. albicans as the affecting pathogen. Hourly administration of voriconazole 1% eye drops was initiated as antifungal therapy. The corneal infiltrate began to resolve and the epithelial defect decreased in size within 2 days. Visual acuity improved to 20/120. After 4 days of voriconazole use, the epithelial defect was completely healed and visual acuity was 20/30 in the affected eye. No fungi were isolated from a second eye scrape. Discussion: Topical voriconazole as salvage monotherapy to manage fungal keratitis has been previously reported. It can be argued, however, that the primary therapy has facilitated the positive response to subsequent topical voriconazole. To date, there has been no solid evidence to suggest that topical voriconazole is effective when used as primary therapy. The current report provides evidence of topical voriconazole demonstrating clinical success when used as first-line therapy to treat C. albicans keratitis. The use of topical voriconazole can reduce the costs, toxicity, and drug interactions associated with common antifungal therapies. Conclusions: Topical voriconazole 1% eye drops administered alone demonstrated success as first-line therapy against the most common fungal keratitis, C. albicans keratitis.