Effect of antibiotic drops on adverse events during extended lens wear.
OBJECTIVE
Overnight lens wear is associated with increased lens contamination and risk of developing a corneal infiltrate or infectious event. Antibacterial lenses have been proposed as a potential strategy for reducing lens contamination. A proof-of-principle study was conducted to investigate what effect control of potential pathogens, through the use of antibiotic eye drops, would have on the incidence of corneal infiltrative events (CIEs) and on the ocular microbiota and lens contamination.


METHODS
This is a prospective, open-label, controlled, parallel-group, 1-month clinical study in which 241 subjects were dispensed with lotrafilcon A silicone hydrogel lenses for 30 days of continuous wear. Subjects were randomized into either test (moxifloxacin 0.5%) or control (rewetting solution) group. One drop was instilled into each eye on waking and before sleeping, while lenses were on-eye. Follow-ups were conducted after one night and 1 month. Lid margin swabs were taken at baseline and at 1 month and worn lenses were aseptically collected at 1 month.


RESULTS
The incidence of CIEs was not significantly different between the test (2.6%) and control (3.9%) groups (p = 0.72). Microorganism levels from the test group swabs were significantly lower than those from the control group (p = 0.001). Gram-positive bacteria were less frequently recovered from lower lid swabs from the test group (39.6% vs. 66.0% [p < 0.001], test vs. control, respectively) or from contact lens samples (1.9% vs. 10.5% [p = 0.015], test vs. control, respectively), but there was no difference in gram-negative bacteria (GNB). Corneal infiltrative events were associated with higher levels of lens contamination (p = 0.014) and contamination of lenses with GNB (CIE: 7.3% vs. 0.6% [p = 0.029], GNB contamination vs. no GNB contamination, respectively).


CONCLUSIONS
Twice-daily antibiotic instillation during continuous wear of lenses did not significantly influence the rate of inflammatory events. Corneal infiltrative events were associated with higher levels of lens contamination in general and with contamination by GNB specifically.
*BOptom †PhD, FBCLA, FAAO, MASM ‡MBBS, DO §BSc(Optom) ∥PhD **PhD, DSc, FAAO Brien Holden Vision Institute (JO, HZ, PLdlJ, TN, BAH); and School of Optometry and Vision Science, University of New South Wales (JO, MDPW, HZ, PLdlJ, BAH), Sydney, New South Wales, Australia; and LV Prasad Eye Institute (VR, DS), Hyderabad, India.
Jerome
J
Ozkan
Mark D P
MD
Willcox
Varsha M
VM
Rathi
Dumpati
D
Srikanth
Hua
H
Zhu
Percy Lazon
PL
de la Jara
Thomas
T
Naduvilath
Brien A
BA
Holden
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001372:Aza Compounds / Q000627:therapeutic use*; D003262:Contact Lenses, Extended-Wear / Q000382:microbiology*; D003320:Corneal Ulcer / Q000382:microbiology*; D004866:Equipment Contamination / Q000517:prevention & control / Q000706:statistics & numerical data*; D015818:Eye Infections, Bacterial / Q000382:microbiology*; D005143:Eyelids / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D020100:Hydrogels; D008297:Male; D064307:Microbiota / Q000187:drug effects* / Q000502:physiology; D008875:Middle Aged; D000077266:Moxifloxacin; D009883:Ophthalmic Solutions; D011446:Prospective Studies; D011804:Quinolines / Q000627:therapeutic use*; D012828:Silicones; D055815:Young Adult; D005466:Fluorocarbons
D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D020100:Hydrogels; D000077266:Moxifloxacin; D009883:Ophthalmic Solutions; D011804:Quinolines; D012828:Silicones; C481129:lotrafilcon A; D005466:Fluorocarbons