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Ocular penetration of levofloxacin, ofloxacin and ciprofloxacin in eyes with functioning filtering blebs: investigator masked, randomised clinical trial

Indiana University School of Medicine, Indianapolis, IN, USA

Correspondence to:
L B Cantor, Department of Ophthalmology/Glaucoma Service, Indiana University School of Medicine, 702 Rotary Cir, Room 141, Indianapolis, IN 46202, USA; lcantor{at}iupui.edu

Background/aims: To compare the penetration of levofloxacin, ofloxacin and ciprofloxacin in the aqueous humour of eyes with functioning filtering blebs.

Methods: In this investigator-masked study, 48 patients with functioning filtering blebs requiring cataract surgery were randomised into six groups of eight patients. Groups 1, 2 and 3 received topical ofloxacin 0.3% (Ocuflox®), ciprofloxacin 0.3% (Ciloxan®) and levofloxacin (Quixin®) respectively; Groups 4, 5 and 6 received the same treatment with the corresponding oral dose of ofloxacin 400 mg (Floxin), ciprofloxacin 400 mg (Cipro) and levofloxacin 250 mg (Levaquin). Aqueous antibiotic levels were determined by mass spectrometry of aqueous samples from each patient.

Results: The mean aqueous level for topical levofloxacin was significantly higher than those achieved by topical ofloxacin or ciprofloxacin (p value = 0.02 and 0.01, respectively). The combination of topical and oral levofloxacin was significantly higher than topical levofloxacin alone (p = 0.05) and the ciprofloxacin combination (p = 0.003) but not significantly higher than the ofloxacin combination therapy.

Conclusions: Topical levofloxacin penetrates better than ofloxacin or ciprofloxacin into the aqueous of eyes with functioning filtering blebs. The combination of topical and oral levofloxacin may be preferable in the treatment of bleb-associated infections (NCT 00392275; Clinical trials.gov).

Competing interests: None.

Patient consent: The study protocol and informed consent were approved by the appropriate Institutional Review Board; written informed consent was obtained from all enrolled patients and the study complied with the Declaration of Helsinki.