PURPOSE: 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 toleranceafter penetrating keratoplasty. METHODS: In this prospective, single-center, randomized study, patients undergoing penetrating keratoplasty receivedpostoperative 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. CONCLUSION: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.
RCT Entities:
PURPOSE: 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. CONCLUSION: 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: Katrin Wacker; Sophy Denker; Antonia Hildebrand; Philipp Eberwein; Thomas Reinhard; Johannes Schwartzkopff Journal: PLoS One Date: 2013-12-09 Impact factor: 3.240