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Frank A Bucci Jr, Breanne Michalek, Angel T Fluet Bucci Laser Vision Institute, Wilkes-Barre, PA, USA Purpose: The objective of this study is to evaluate whether a phenylephrine and ketorolac injection 1%/0.3% (phenyl/keto injection) (Omidria®) prior to capsulotomy decreases the need for the Malyugin Ring® to manage small pupils.Setting: Bucci Laser Vision Institute, Wilkes-Barre, PA, USA.Design: Retrospective analysis of cataract surgeries performed by a single surgeon at a single center.Methods: A historical control group of 1,004 consecutive cases (December 2013 to February 2015) did not receive a phenyl/keto intracameral injection prior to capsulotomy and were compared with 915 consecutive cases in the treatment group (June 2015 to April 2016) for the rate of use of the Malyugin Ring. Epinephrine injections were selectively used in the control group as per surgeon judgment. Use of the femtosecond laser was recorded for both groups. The incidence of alpha-1 blocker patients and the use of the femtosecond laser were recorded for both groups.Results: In the 1,004 cases performed in the historical control group without a phenyl/keto injection, the surgeon chose to use the Malyugin Ring 79 times (7.87%). In the 915 cases performed in the treatment group, the surgeon chose to use the Malyugin Ring 27 times (2.95%). The surgeon selectively used intracameral injections of epinephrine in the control group 64 times (6.47%). There was no significant difference in the use of the femtosecond laser in the control group (15.04%) versus the treatment group (16.28%); however, 4 (2.65%) femtosecond patients in the control group required a Malyugin Ring, while zero patients needed the ring in the femtosecond treatment group. The incidence of Malyugin Ring use in alpha-1 blocker patients was 12/49 (24.49%) in the control group and 6/49 (12.74%) in the treatment group (P=0.05).Conclusion: The frequency of use of the Malyugin Ring was significantly reduced (P<0

Frank A Bucci Jr, Ines Teuma Nguimfack, Angel T Fluet Bucci Laser Vision Institute, Wilkes-Barre, PA, USA Purpose: The objective of this study was to compare the pharmacokinetics of levofloxacin 1.5% and moxifloxacin hydrochloride 0.5% ophthalmic solutions in aqueous humor after multiple doses prior to cataract surgery. Methods: Ninety-eight eyes underwent cataract surgery and met the requirements of PK analysis. Eligible eyes were randomly assigned in a 1:1 ratio to receive levofloxacin or moxifloxacin prior to cataract surgery and were randomized into one of four sampling time points (ie, 1, 2, 4, and 6 hour post-last dose). Randomization was investigator and laboratory-masked. Three days prior to cataract surgery, each patient instilled one drop of the assigned study medication into the operative eye four times daily. One aqueous humor specimen was collected from the eye at the randomized time point. Aqueous humor specimens were assayed for drug concentration using a validated liquid chromatography and tandem mass spectrometer. Results: Concentrations of the drug in the aqueous humor, as described by mean Cmax and pooled AUC0–6 values, were greater for levofloxacin than moxifloxacin (Cmax: 1.43, 0.87 µg/ml, respectively, P=0.008; AUC0–6 6.1, 3.8 µg·min/ml, P<0.001 respectively). No treatment-emergent adverse events were reported. Conclusion: Significantly greater drug exposures were attained in aqueous humor following the administration of levofloxacin 1.5% than moxifloxacin 0.5% ophthalmic solution. Achieving considerable higher drug concentration in the aqueous humor with levofloxacin 1.5% may demonstrate a greater potential for bacterial eradication. Keywords: concentration, endophthalmitis, antibiotics, phacoemulsification, prophylaxis, fluoroquinolone

Frank A Bucci Jr,1 Ruth E Evans,1 Loretta M Amico,1 Timothy W Morris,2 Angel T Fluet,1 Christine M Sanfilippo,3 Heleen H DeCory,3 Timothy L Comstock3 1Bucci Laser Vision Institute, Wilkes-Barre, PA, USA; 2Microbiology and Sterilization Sciences, Bausch and Lomb, Rochester, NY, USA; 3Medical Affairs, Bausch and Lomb, Rochester, NY, USA Background: The purpose of this study was to investigate the ocular bacterial flora in patients scheduled to undergo cataract surgery and compare the antibacterial effects of besifloxacin ophthalmic suspension 0.6% and moxifloxacin ophthalmic solution 0.5% in these patients. Methods: This was a prospective, randomized, laboratory-masked clinical trial. Patients received besifloxacin or moxifloxacin “quater in die” or QID (four times a day) for 3 days before cataract surgery in the surgical eye and 1 hour before surgery in the nonsurgical fellow eye. Conjunctival and eyelid swabs were obtained from both eyes at baseline and after treatment, on the day of surgery (Visit 2). Swabs were processed for bacterial colony counts (in terms of colony-forming units) and species identification. In vitro antibiotic susceptibilities of isolates were determined using Clinical and Laboratory Standards Institute breakpoints. Results: Fifty-nine patients (n=28 besifloxacin, n=31 moxifloxacin) completed the study. The majority (73%) of conjunctival samples were culture negative at baseline. The most frequent isolates were coagulase-negative staphylococci (CoNS, 89%), specifically Staphylococcus epidermidis (72%). Both fluoroquinolones reduced the lid CFU values when administered QID for 3 days (P≤0.019), but only besifloxacin reduced the lid CFU estimate 1 hour following instillation of a single drop (P=0.039). Fewer besifloxacin-treated eyes had lids that were culture positive for CoNS at Visit 2 compared with moxifloxacin-treated eyes regardless of dosing regimen (P≤0.03). The minimum inhibito

Randall Olson1, Eric Donnenfeld2, Frank A Bucci Jr3, Francis W Price Jr4, Michael Raizman5, Kerry Solomon6, Uday Devgan7, William Trattler8, Steven Dell9, R Bruce Wallace10, Michelle Callegan11, Heather Brown11, Peter J McDonnell12, Taryn Conway13, Rhett M Schiffman13, David A Hollander131The John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA; 2Ophthalmic Consultants of Long Island and Connecticut, Rockville Centre, NY, USA; 3Bucci Laser Vision Institute, Wilkes-Barre, PA, USA; 4Price Vision Group, Indianapolis, IN, USA; 5Ophthalmic Consultants of Boston, Boston, MA, USA; 6Department of Ophthalmology, Medical University of South Carolina, Charleston, SC, USA; 7Maloney Vision Institute, Los Angeles, CA, USA; 8Center for Excellence in Eye Care, Miami, FL, USA; 9Dell Laser Consultants, Austin, TX, USA; 10Wallace Eye Surgery, Laser and Surgery Center, Alexandria, LA, USA; 11Department of Ophthalmology, University of Oklahoma Health Sciences Center, Dean A. McGee Eye Institute, Oklahoma City, OK, USA; 12Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore, MD, USA; 13Allergan Inc., Irvine, CA, USAPurpose: The purpose of this study is to characterize the bacterial flora of the ocular and periocular surface in cataract surgery patients and to determine the prevalence of methicillin resistance among staphylococcal isolates obtained from health care workers (HCWs) and non-HCWs.Methods: In this prospective, multicenter, case series study, eyelid and conjunctival cultures were obtained from the nonoperative eye of 399 consecutive cataract patients on the day of surgery prior to application of topical anesthetics, antibiotics, or antiseptics. Speciation and susceptibility testing were performed at the Dean A. McGee Eye Institute. Logistic regression was utilized to evaluate whether any factors were significant in predicting the presence of methicillin-resistant staphylococcal isolates.Results: Staphylococcus epidermidis (62.9%), fo