title: Bag and chamber flushing: a new method of using intracameral moxifloxacin to irrigate the anterior chamber and the area behind the intraocular lens.
abstract: BACKGROUND
  Intracameral moxifloxacin is currently administered by injecting small doses (0.05-0.2 mL) of either undiluted or diluted solutions. It is difficult to ensure delivery of small amounts of antibiotic into the area behind the intraocular lens (IOL). Moreover, the anterior chamber pressure decreases as the tip of irrigation is removed, often leading to contaminated fluid flowing into the chamber. Conventional intracameral injection administers the diluted antibiotic without irrigating the recontaminated anterior chamber. Therefore, we developed a method of intracameral moxifloxacin delivery which flushes both the anterior chamber and the area behind the IOL immediately after surgery.
  
  
  METHODS
  Surgical technique (bag and chamber flushing = BC flushing): After removing the viscosurgical device, 1.5-1.8 mL diluted moxifloxacin was injected. Both the anterior chamber and the area behind the IOL were irrigated by lifting the IOL edge so that a stream of solution could circulate behind the IOL. Experiment 1 (pig): The anterior chamber was filled with condensed milk, and irrigated with 150-fold diluted moxifloxacin (33.3 μg/mL) in six eyes (BC flushing) to observe the irrigating effect. The anterior aqueous humor was sampled. Experiment 2 (human): A conventional intracameral injection (500 μg/mL) or BC flushing (33.3 μg/mL) was followed by sampling 0.1 mL of the anterior aqueous humor in six eyes each. High-performance liquid chromatography was performed to determine antibiotic levels.
  
  
  RESULTS
  Experiment 1: The antibiotic concentration in the anterior chamber was 33.0 μg/mL (99.0 % was displaced). The area behind the IOL was not effectively irrigated without inserting the cannula tip. Experiment 2: The final antibiotic concentration was 152.3 μg/mL using the conventional method and 29.4 μg/mL using the BC flushing (88.3 % was displaced).
  
  
  CONCLUSIONS
  BC flushing technique enables surgeons to completely displace the anterior chamber including the posterior IOL surface, resulting in effective irrigation and a stable antibiotic concentration in virtually all cases.
authors: Nojima Hospital, 2714-1 Sesaki-machi, Kurayoshi-city, Tottori 682-0863, Japan. i-mnys2001@za.ztv.ne.jp
authors: Kazuki
authors: K
authors: Matsuura
authors: Chikako
authors: C
authors: Suto
authors: Junsuke
authors: J
authors: Akura
authors: Yoshitsugu
authors: Y
authors: Inoue
mesh_terms: D000818:Animals; D000867:Anterior Chamber / Q000187:drug effects*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000032:analysis; D001082:Aqueous Humor / Q000737:chemistry; D001372:Aza Compounds / Q000008:administration & dosage* / Q000032:analysis; D057785:Catheters; D002851:Chromatography, High Pressure Liquid; D009877:Endophthalmitis / Q000517:prevention & control; D024841:Fluoroquinolones; D006801:Humans; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D000077266:Moxifloxacin; D057852:Posterior Capsule of the Lens / Q000187:drug effects*; D011804:Quinolines / Q000008:administration & dosage* / Q000032:analysis; D013552:Swine; D007507:Therapeutic Irrigation / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D000077266:Moxifloxacin