title: Intraocular penetration of vancomycin eye drops after application to the medial canthus with closed lids.
abstract: OBJECTIVE
  To investigate the intraocular penetration of vancomycin eye drops and to compare the conventional method of drop instillation to the lower cul de sac with applying drops to the medial canthus with closed lids.
  
  
  METHODS
  This prospective randomised trial evaluated 53 eyes of 53 patients who had undergone extracapsular cataract extraction (ECCE) with intraocular lens implantation. Vancomycin (50 mg/ml) eye drops were applied to either the lower cul de sac with open lids (conventional method), or to the medial canthus with the patient in a supine position and with closed lids. After paracentesis performed during ECCE, an aqueous humour sample was taken and vancomycin concentration was measured using the TDX vancomycin assay (fluorescence polarisation immunoassay).
  
  
  RESULTS
  Vancomycin concentration in the anterior chamber were above the minimal inhibitory concentration for Gram positive bacteria in the two methods of drop instillation examined (2.04 (SD 1.9) microg/ml and 1.49 (1.1) microg/ml in the open and closed methods, respectively (p =0.202)).
  
  
  CONCLUSIONS
  Vancomycin (50 mg/ml) reaches therapeutic concentration in the anterior chamber after topical drop application. Comparable concentrations were reached when drops were applied in either the lower cul de sac or to the medial canthus with closed lids. The latter method is proposed as likely to improve patient compliance.
authors.affiliation: Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Alster
authors.forename: L
authors.initials: L
authors.lastname: Herlin
authors.forename: M
authors.initials: M
authors.lastname: Lazar
authors.forename: A
authors.initials: A
authors.lastname: Loewenstein
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology; D002387:Cataract Extraction; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D014640:Vancomycin / Q000008:administration & dosage* / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D009883:Ophthalmic Solutions; D014640:Vancomycin