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   Table of Contents      
LETTER TO EDITOR
Year : 2004  |  Volume : 52  |  Issue : 1  |  Page : 79

Sparfloxacin corneal deposits


Correspondence Address:
Nikhil S Gokhale


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Source of Support: None, Conflict of Interest: None


PMID: 15132389

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How to cite this article:
Gokhale NS. Sparfloxacin corneal deposits. Indian J Ophthalmol 2004;52:79

How to cite this URL:
Gokhale NS. Sparfloxacin corneal deposits. Indian J Ophthalmol [serial online] 2004 [cited 2019 Nov 22];52:79. Available from: http://www.ijo.in/text.asp?2004/52/1/79/14622

Dear Editor,

Fluoroquinolones are broad spectrum, bactericidal agents with activity against both gram-positive and gram-negative corneal pathogens. Topical fluoroquinolones are widely used in the treatment of bacterial corneal ulcers. They are safe, but a white crystalline deposit, that in most cases spontaneously dissolves, has been reported with topical ciprofloxacin 0.3% and norfloxacin 0.3% and very recently with ofloxacin 0.3%.[1],[2],[3] Sparfloxacin, a newer quinolone, is now available as 0.3% eye drops for the treatment of serious corneal and conjunctival infections. It has better penetration and a high therapeutic index. I noticed sparfloxacin corneal deposits after prolonged topical use in four patients. Two patients were treated for graft infiltrate and two for corneal ulcer. A representative case is described briefly.

Case

A 65-year-old patient presented with acute dacryocystitis in her right eye. She had previously undergone corneal grafts for bullous keratopathy in both eyes. The grafts in both eyes were clear at presentation and she was on prednisolone acetate 1 % eye drops once daily in both eyes. She was prescribed sparfloxacin eye drops 0.3% five times a day in the right eye along with oral amoxycillin 500 mg and ibuprofen 400 mg + paracetamol 325 mg combination, both thrice daily for 5 days. The patient did not return for follow up and continued using the drops. On her next visit two months later, multiple refractile crystalline deposits were seen in the corneal graft. The deposits were seen throughout the stroma and also along the suture tracks (Figure). The eye was quiet, there was no inflammation and the patient was asymptomatic. She was advised to discontinue topical sparfloxacin and continue the topical prednisolone only. She was also advised a dacryocystorhinostomy in the right eye. At her next visit two months later the graft was clear with complete resolution of the deposits.

Comments

Analysis of ciprofloxacin, norfloxacin and ofloxacin eye drops related drug deposits have confirmed the presence of quinolones. The specific factors contributing to the formation of the fluoroquinolone precipitate are unknown, but pH solubility profiles are of importance. Sparfloxacin is deposited as a refractile crystalline deposit in all layers of the corneal stroma. Deposits can develop in the absence of an epithelial defect, ulceration or inflammation. Unlike surface deposits noted with other quinolones, sparfloxacin is deposited throughout the corneal stroma. The deposits do not cause any inflammation and patients are asymptomatic. This was not suspected initially. However the absence of any other known cause of crystalline corneal deposits suggested a possibility of drug deposition. The deposits also resolved on discontinuation of sparfloxacin drops. The deposits can be analysed biochemically only if a corneal graft or biopsy is done in a patient who has these deposits. Clinicians should be aware that refractile deposits can occur after prolonged topical use of sparfloxacin; these deposits resolve slowly after cessation of therapy

 
  References Top

1.
Castillo A, Benitez Del Castillo JM, Toledano N, Diaz-Valle D, Sayagues O, Garcia-Sanchez J. Deposits of topical norfloxacin in the treatment of bacterial keratitis. Cornea 1997;16:420-23.  Back to cited text no. 1
[PUBMED]    
2.
Eiferman RA, Snyder JP, Nordquist RE. Ciprofloxacin microprecipitates and macroprecipitates in the human corneal epithelium. J Cataract Refract Surg 2001;27:1701-2.   Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.
Claerhout I, Kestelyn Ph, Meire F, Remon JP, Decaestecker T, Van Bocxlaer J. Corneal deposits after the topical use of ofloxacin in two children with vernal keratoconjunctivitis. Br J Ophthalmol 2003;87:646.  Back to cited text no. 3
    


    Figures

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