Chemical Treatment with Fluoroquinolones on the Tear Film and Ocular Surface after Cataract Surgery

Quinolone antibacterial activity is related to its chemical structure, a synthetic fluorinated analog of nalidixic acid. Cataract surgery is responsible for visual improvement having a major positive impact on the quality of patients lives. According to the international guidelines, the administration of levofloxacin after cataract surgery decreases the incidence of postoperatively endophthalmitis. In this context we aimed to study the impact of adding topical fluoroquinolones to the conventional treatment after cataract surgery on the ocular surface and tear film. 125 of eyes of 125 patients with cataract were included. The enrolled patients were divided into three groups, a control group of patients that received topical Tobramycin, Dexamethasone and Indomethacin, a second group where moxifloxacin was added and a third group with levofloxacin instead of moxifloxacin. For all the patients, tear film breakup time, Schirmer II test, slit lamp examination preoperatively and postoperatively at one week were performed together with individual Ocular Surface Disease Index at one week after cataract surgery. The test results revealed that 52% of our studied patients had an abnormal preoperatively tear film breakup time, and 76.8% after cataract surgery, with a statistically significant decrease of the measured values. The preoperatively measured quantity of tears presented a no statistically significant decrease one week after cataract surgery. Also, we found an increase in the percentage of patients with punctate epithelial erosions. It is important and useful to identify prior to surgery patients with ocular surface disease and the ones at risk to develop clinical manifestations in order to treat them accordingly because, cataract surgery exacerbates the preexistent ocular symptoms. The addition of topical fluoroquinolones after cataract surgery in patients with dry eye is safe, with minimal alterations of the ocular surface and tear production, without statistically significant differences as compared to the control group.