title: A comparison of azithromycin and tobramycin eye drops on epithelial wound healing and tolerance after penetrating keratoplasty.
abstract: OBJECTIVE
  After keratoplasty, antibiotic eye drops are used to prevent ocular infection until the recipient corneal epithelium has healed. We compared the effects of azithromycin, a new macrolide, with the effect of the standard antibiotics, tobramycin, on the (i) prevention of infection, (ii) epithelial healing, and (iii) ocular tolerance after penetrating keratoplasty.
  
  
  METHODS
  In this prospective, single-center, randomized study, patients undergoing penetrating keratoplasty received postoperative topical dexamethasone and either azithromycin (n=23; Azyter(®); one drop twice daily for 3 days) or tobramycin (n=23; Tobrex(®); 1 drop 4 times daily until complete re-epithelialization). Daily slit-lamp examination with fluorescein was performed, and photographs were taken to digitally assess the re-epithelialized surface area. Daily questionnaires assessed ocular comfort and pain.
  
  
  RESULTS
  There were no cases of infection in either group. The re-epithelialized area of the corneal graft increased at a similar rate in each group, with no difference between the groups on any day. The mean±SD days until complete re-epithelialization did not differ between tobramycin (4.14±1.17) and azithromycin (4.13±1.82) (P=0.89). Superficial punctate keratitis scores were similar for tobramycin (1.39) and azithromycin (1.34). Pain and discomfort scores improved each day after surgery with no differences between the groups on any day.
  
  
  CONCLUSIONS
  Postkeratoplasty epithelial healing and ocular tolerance were not significantly different between the azithromycin- and tobramycin-treatment groups. Our results support the use of azithromycin as an alternative to tobramycin after corneal surgery such as keratoplasty.
authors.affiliation: Service d'Ophtalmologie, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Blavin
authors.forename: Arnaud
authors.initials: A
authors.lastname: Sauer
authors.forename: Maher
authors.initials: M
authors.lastname: Saleh
authors.forename: David
authors.initials: D
authors.lastname: Gaucher
authors.forename: Claude
authors.initials: C
authors.lastname: Speeg-Schatz
authors.forename: Tristan
authors.initials: T
authors.lastname: Bourcier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003315:Cornea / Q000254:growth & development / Q000473:pathology; D003316:Corneal Diseases / Q000473:pathology / Q000601:surgery; D003907:Dexamethasone / Q000627:therapeutic use; D019573:Epithelium, Corneal / Q000254:growth & development / Q000473:pathology; D005260:Female; D006801:Humans; D007634:Keratitis / Q000473:pathology; D015948:Keratoplasty, Penetrating / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D010149:Postoperative Pain / Q000453:epidemiology; D011184:Postoperative Period; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control; D014031:Tobramycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014945:Wound Healing / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D009883:Ophthalmic Solutions; D003907:Dexamethasone; D017963:Azithromycin; D014031:Tobramycin