title: The effectiveness of a topical antibiotic irrigating solution in a model of staphylococcal keratitis after lamellar keratectomy.
abstract: OBJECTIVE
  To create a model of Staphylococcus aureus keratitis after lamellar keratectomy; to assess the toxicity of an antibiotic irrigating solution on the corneal stromal bed; and to test the chemotherapeutic effectiveness of a topical antibiotic, both alone and with an antibiotic-containing irrigating solution in preventing S. aureus keratitis after lamellar keratectomy.
  
  
  METHODS
  The right eye of each of 38 rabbits were used in this study. In 18 eyes, a lamellar flap was created with a microkeratome, and an inoculum of S. aureus (either 1,000, 5,000, or 50,000 CFUs) was instilled under each flap; the eyes were examined for signs of infection and inflammation at 24 and 48 hours. In another five eyes, a lamellar flap was created in the same manner and the stromal bed was irrigated with 0.3% ofloxacin; the eyes were assessed for ocular inflammatory changes and evidence of crystalline deposits. Finally, in each of 15 additional eyes, 1,000 CFUs of S. aureus were instilled under a lamellar flap to create experimental infectious keratitis. The keratitis was treated according to three regimens: irrigation of the stromal bed with sterile balanced salt solution; irrigation of the stromal bed with 0.3% ofloxacin, followed by application of topical ofloxacin four times a day; application of topical ofloxacin only, four times a day. Eyes were examined for infection and ocular inflammatory changes at 24 and 48 hours.
  
  
  RESULTS
  Staphylococcus aureus keratitis can consistently be produced under the stromal flap by inoculation of relatively few organisms. Irrigation of the stromal bed with commercial-strength topical ofloxacin does not appear to be toxic to the stromal bed, with no evidence of crystalline precipitates of the antibiotic. In our model of infectious keratitis after lamellar keratectomy, both topical ofloxacin alone and the combination of topical ofloxacin and irrigation of the stromal bed with 0.3% ofloxacin were effective at preventing S. aureus keratitis. However, the combined treatment of antibiotic irrigation plus topical antibiotic was more effective at preventing inflammation than topical ofloxacin alone.
  
  
  CONCLUSIONS
  In this model of S. aureus keratitis after lamellar keratectomy, irrigation of the stromal bed with antibiotic plus topical antibiotic appears to be both safe and effective for preventing infection.
authors.affiliation: Doheny Eye Institute and the Departments of Ophthalmology, University of Southern California School of Medicine, Los Angeles, California, USA.
authors.forename: S N
authors.initials: SN
authors.lastname: Rao
authors.forename: Y
authors.initials: Y
authors.lastname: Fong
authors.forename: J
authors.initials: J
authors.lastname: Kampmeier
authors.forename: L D
authors.initials: LD
authors.lastname: LaBree
authors.forename: D J
authors.initials: DJ
authors.lastname: Tanzer
authors.forename: P J
authors.initials: PJ
authors.lastname: McDonnell
mesh_terms: D000287:Administration, Topical; D000818:Animals; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D015169:Colony Count, Microbial; D003319:Corneal Stroma / Q000187:drug effects / Q000382:microbiology; D016039:Corneal Transplantation / Q000009:adverse effects*; D003320:Corneal Ulcer / Q000382:microbiology / Q000473:pathology / Q000517:prevention & control*; D004195:Disease Models, Animal; D015818:Eye Infections, Bacterial / Q000382:microbiology / Q000473:pathology / Q000517:prevention & control*; D008826:Microbial Sensitivity Tests; D015242:Ofloxacin / Q000627:therapeutic use*; D009883:Ophthalmic Solutions / Q000627:therapeutic use*; D011817:Rabbits; D012449:Safety; D013203:Staphylococcal Infections / Q000382:microbiology / Q000473:pathology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D009883:Ophthalmic Solutions; D015242:Ofloxacin