Change in Ocular Flora Resistance From Repeated Topical Antibiotic Use

Study Overview
=================
Brief Summary
-----------------
The purpose of this study is to determine if antibiotic resistance of the ocular surface flora to the 4th generation fluoroquinolones will increase after repeated use of topical antibiotics for three days post intravitreal injection.

Detailed Description
-----------------
Treatment with intravitreal (IVT) injections has increased during the last several years as evidence has accumulated demonstrating the efficacy of anti-vascular endothelial growth factor agents in the treatment of neovascular age-related macular degeneration (AMD) and various retinal vascular diseases. Although IVT injections are generally safe, infectious endophthalmitis is a rare but devastating complication, and the risk of morbidity and vision loss from endophthalmitis is high. The objective is to examine the change in antibiotic resistance of ocular surface flora with repeated prophylactic use of antibiotics after IVT injection for AMD. Yin, V. T., Weisbrod, D. J., Eng, K. T., Schwartz, C., Kohly, R., Mandelcorn, E., Lam, W., Daneman, N., Simor, A., & Kertes, P. J. (2013). Antibiotic resistance of ocular surface flora with repeated use of a topical antibiotic after intravitreal injection. JAMA ophthalmology, 131(4), 456-461.

Official Title
-----------------
Antibiotic Resistance of Ocular Surface Flora After Continued Use of Topical Antibiotics Post Intravitreal Injections

Conditions
-----------------
Increased Drug Resistance, Infection Resistant to Quinolones and Fluoroquinolones

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: patients scheduled for intravitreal injection for neovascular age-related macular degeneration (ARMD) 65 years or older able to provide informed consent. Exclusion Criteria: diagnosed with an active ocular, periocular or systemic infection previously received treatment with an intravitreal injection previously treated with antibiotics in the past three months unable to attend the scheduled follow-up appointments or to complete treatment for any reason

Ages Eligible for Study
-----------------
Minimum Age: 65 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Antibiotic<br>No prophylactic antibiotic post intravitreal injection | |
| Prophylactic Antibiotic<br>Group treated with 3 day course of prophylactic topic antibiotic, fourth generation fluoroquinolones, after each intravitreal injection | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ocular flora resistance to 4th generation fluoroquinolone | Outcome will examine the change in amount, type and antibiotic resistance profile of ocular surface flora over the 3 months. Charcoal swab of the conjunctiva will be cultured, organisms grown will be identified and resistance to moxifloxacin will be quantified by minimal inhibitory resistance (MIC). | 1 year |