Evaluation of Moxifloxacin 0.

5% in
Treatment of Nonperforated Bacterial
Corneal Ulcers
A Randomized Controlled Trial

Namrata Sharma, MD,1 Manik Goel, MD,1 Shubha Bansal, DNB,1 Prakashchand Agarwal, MD,1 Jeewan S.
Titiyal, MD,1 Ashish D. Upadhyaya, MSc,2 Rasik B. Vajpayee, FRCSEd, FRANZCO1,3

Purpose: To compare the equivalence of moxifloxacin 0.5% with a combination of fortified cefazolin sodium 5%
and tobramycin sulfate 1.3% eye drops in the treatment of moderate bacterial corneal ulcers.
Design: Randomized, controlled, equivalence clinical trial.
Participants and Controls: Microbiologically proven cases of bacterial corneal ulcers were enrolled in the study
and were allocated randomly to 1 of the 2 treatment groups.

Intervention: Group A was given combination therapy (fortified cefazolin sodium 5% and tobramycin sulfate)
and group B was given monotherapy (moxifloxacin 0.5%).

Main Outcome Measures: The primary outcome variable for the study was percentage of the ulcers healed at 3
months. The secondary outcome variables were best-corrected visual acuity and resolution of infiltrates.

Results: Of a total of 224 patients with bacterial keratitis, 114 patients were randomized to group A, whereas
110 patients were randomized to group B. The mean standard deviation ulcer size in groups A and B were 4.2 2
and 4.41 1.5 mm, respectively. The prevalence of coagulase-negative Staphylococcus (40.9% in group A and
48.2% in group B) was similar in both the study groups. A complete resolution of keratitis and healing of ulcers
occurred in 90 patients (81.8%) in group A and 88 patients (81.4%) in group B at 3 months. The observed
percentage of healing at 3 months was less than the equivalence margin of 20%. Worsening of ulcer was seen
in 18.2% cases in group A and in 18.5% cases in group B. Mean time to epithelialization was similar, and there
was no significant difference in the 2 groups (P 0.065). No serious events attributable to therapy were reported.

Conclusions: Corneal healing using 0.5% moxifloxacin monotherapy is equivalent to that of combination
therapy using fortified cefazolin and tobramycin in the treatment of moderate bacterial corneal ulcers.

Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in
this article. Ophthalmology 2013;120:11731178 2013 by the American Academy of Ophthalmology.
acombinationof2antibacterialdrugstocoverbothgram
negativeandgrampositiveorganisms.

1517

Microbialkeratitisisanophthalmicemergencyandrequires
meticulousmanagementtopreventsightthreateningcom
plications.

13

Bacterialkeratitisaccountsforasignificant
4,5

proportionofinfectiouskeratitisworldwide andmayhave
diverseclinicalpresentationdependingonthegeographical
6

locationandclimaticconditions. Grampositivebacteriasuch
ascoagulasenegativeStaphylococcus,Staphylococcus
aureus,andStreptococcusspeciesaccountformostthe
organismsisolated.

Thisprospective,randomizedstudywasconductedto
evaluateandcomparetheefficacyandsafetyofcombina
tiontherapyoffortified5%cefazolinsodiumand1.3%
tobramycinsulphateeyedropsversusmonotherapywith
0.5%moxifloxacinhydrochlorideeyedropsinpatients
withbacterialcornealulcers.

79

Patients and Methods

Theprotocolforthemanagementofbacterialkeratitisideally
involvescollectionofcornealscrapingmaterialforsmearand
cultureandstartingempiricalintensiveantimicrobialtherapy
untilcultureandantibioticsensitivityreportsareavailable.
However,atsomecenters,presumedbacterialinfiltrateswith
anoverlyingepithelialdefectmaybetreatedempirically
withoutmicrobiologicstudies.Theregimensofempirical
therapypracticedacrosstheworldareeithermonotherapy
withabroadspectrumantibiotic

1014

or

Study Design

Arandomized,prospectivestudywasconductedinwhich224
patientswithprovenbacterialcornealulcerswereenrolledfrom
thecorneaservicesofourcenter.Theywereassignedrandomly
into1ofthe2groupsusingacomputergeneratedrandomnumber
table.Oneeyeofeachpatientwasenrolled.Theclinicaltrialwas
registeredathttp://www.controlledtrials.com(no.

2013bytheAmericanAcademyofOphthalmologyPublishedbyElsevierInc.

ISSN01616420/13/$seefrontmatter

http://dx.doi.org/10.1016/j.ophtha.2012.11.013

1173

Ophthalmology Volume 120, Number 6, June

2013
ISRCTN10323655/11/08/201
0).Bacterialcornealulcers
measuring2to8mmwere
identifiedaswellasthe
presenceofinfiltrate,for
whichadiagnosticscraping
hadbeenperformedandthat
showedasignificantpresence
ofbacteriaoncorneal
scrapingorculture.GroupA
receivedtopicalfortified
cefazolinsodium(50mg/ml)
andfortifiedtobramycin
sulphate(14mg/ml)eye
drops,whereasgroupB
receivedtopicalmoxifloxacin
hydrochloride(0.5%;
Vigamox;Alcon
Laboratories,Inc.,Fort
Worth,TX).Thedrugwas
dispensedbyanindependent
investigator.Thestudywas
approvedbytheethics
committeeoftheAllIndia
InstituteofMedicalSciences,
NewDelhi,India,andwritten
informedconsentwas
obtainedfromallthepatients
includedinthestudy.

Patientswithsuspected
fungal,viral,or
acanthamoebaulcersand
patientswithknownallergy
tofluoroquinolones,
aminoglycosides,penicillins,
orcephalosporinswere
excludedfromthestudy.
Pregnantandlactatingwomen
andpatientsyoungerthan12
yearsalsowereexcluded
fromthestudy.

Study Protocol

Patientswereexaminedbya
singleinvestigator(N.S.)who
wasmaskedtothestudy
medication.Thestudy

medicationsweredispensed
byanotherinvestigatorwho
wasunawareoftheclinical
findingsandinvestigations.
Allpatientsunderwenta
meticuloushistorytaking,
whichincludedthe
demographicprofile,duration
andtypeofsymptoms,and
riskfactors.Acomplete
initialocularexamination
includingrecordofbest
correctedvisualacuity;slit
lampbiomicroscopytoassess
thesize,depth,andlocation
oftheulcer;anteriorchamber
reaction;andpresenceand
heightofhypopyonwas
undertaken.Anteriorsegment
photographswereobtained
fromallpatientsateach
clinicalvisit.Astandard
protocolwasusedforthe
initialmicrobiologic
investigationofallpatients
withkeratitis.Atpresentation,
cornealscrapingswere
collectedfromthebaseand
edgesoftheulcerand
examinedwithgramsstain
andpotassiumhydroxidewet
mount.Anypatientswho
demonstratedhyphaeor
acanthamoebacyston
potassiumhydroxidemount
wereexcludedfromthestudy.
Cornealscrapingswereplated
directlyoncultureplatesof
bloodagar,chocolateagar,
Sabouraudsdextroseagar,
andthioglycolatebroth.
Growthinculturemediawas
consideredsignificantifthe
sameorganismwasisolated
onmorethan1culture
mediumwithdirect
microscopyofcornealscrapes
revealingbacterial
morphologicfeatures
consistentwiththoseof
bacteriaisolatedonculture.
Susceptibilityoftheisolates
toantimicrobialswas
assessedbytheKirbyBauer
diskdiffusionmethod.

DosageSchedule.The
dosageschedulewasas
follows.Forthefirst72
hours,antibioticsweregiven
everyhour,dayandnight.
After72hours,thesame
medicationswere
administeredevery2hours
fornext7days,thentapered
accordingtotheclinical
response.Theadditional
supportivetreatmentincluded
cycloplegicandantiglaucoma
therapyifrequired.

Theexaminationfindings
wererecordedondays1,4,7,
14,and21andat3months.
Slitlampbiomicroscopywith
fluoresceinstainingwas
carriedoutateachvisitto
assessthesize,depth,and
locationoftheulcer;anterior
chamberreaction;and
presenceandheightof
hypopyon.Todistinguish
betweenstromalinfiltrates
andcornealscarring,
fluoresceinstainingwas
performedateachfollowup
visit.Stromalinfiltrateis
yellowishandshowsevidence
ofstaining,whereasascaris
whitishanddoesnotstain
withfluorescein.Moreover,a
scarisassociatedwithcorneal
thinning,whereasastromal
infiltratedemonstrates
cornealedemainthe
surroundingareaalongwith
cellularinvasionandnecrosis.
Theabovementioned
parameterswereevaluatedat
eachvisit.Anychangeof
protocol,adverseevent,or
surgicalinterventionwas
documented.Healingwas
definedasclosureofthe
epithelialdefectwith
disappearanceofthestromal
infiltratesatorbefore3

months.Clinicalresponseto
medicationwaspoorifthe
ulcersizeremainedthesame
orincreasedfor72hours.If
thepatientskeratitis
worsened,thetreatmentcode
wasbroken,andthepatient
wasadministeredatreatment
regimendeemedfitbythe
investigator.

Data Analysis and

Statistical Methods

Samplesizeforthestudywas
computedforthehealingrateat
3monthsastheprimary
outcomeina2group
equivalencetrial.Considering
85%asthehealingrateatthe
endof3monthsinthefortified
antibioticsgroupand80%in
themoxifloxacingroup,to
detectanequivalencemarginof
upto20%with80%powerand
95%confidencelevel,the
requirednumberofpatients
was80ineachgroup.Taking
losingpatientstofollowupinto
consideration,aminimumof
100patientsweretobeenrolled
inthestudy.

Comparisonbetweenthe2
treatmentgroupsofthe
distributionofthebaseline
characteristicswascarriedout
usingthechisquaretestor
Fisherexacttestfor
categoricalvariables.
Proportiontestsandthe
analysisofcovariancewas
usedtoassessthedifference
(95%confidenceinterval
[CI])andadjusteddifference
(95%CI)betweenthehealing
ofthe2groupsat3months.
Thedatawereanalyzed
accordingtotheprotocol.
Curewasdefinedasnoevi
denceofactivebacterial
infection,completewound
healing(reepithelialization),

andresolvedsignsof
inflammation.Theinves
tigatorwhonotedthefindings
andthepersonwhodispensed
themedicineswereblindedto
eachother.

Results

Ofatotalof224patientswith
bacterialkeratitisenrolledin
thestudy,114patientswere
randomizedtothefortified
tobramycinandcefazolin
group(groupA)and110
patientswererandomizedto
themoxifloxacingroup
(groupB).Fourpatientswere
losttofollowupingroupA
(2patientsatday7and2
patientsatday14),and2
patientswerelosttofollow
upingroupB(bothpatients
atday7),sothat110patients
ingroupAand108patients
ingroupBwereanalyzed.An
independentinvestigator
followedupwiththepatients,
whowereblindedtothestudy
medications.Therewereno
statisticallysignificant
differencesbetweenthe2
groupsforanydemographic
orbaselinecharacteristics.No
statisticallysignificant
differencewasseeninthe
prestudypathologicfeatures
associatedwithpredisposition
ofcornealulcersinthe2
groups(Table1).

1174

Microbiologic Analysis

Among218gramstain
specimensanalyzed,60
(27.5%)weregrampositive
cocciand13(5.9%)were
gramnegativebacilli.
Positivebacterialculture
resultswereobtainedin175
patients(80.7%),andno
growthwasseenin42cases
(19.4%)(Table2).Amongthe
bacterialisolates,coagulase
negativeStaphylococcus
(40.9%ingroupAand48.2%
ingroupB)wasseenmost
commonlyinbothgroups,
followedbyStaphylococcus
aureus(19.1%ingroupAand
21.3%ingroupB).
Pseudomonasaeruginosawas
isolatedin5.4%ingroupA
andin4.6%ingroupB.There
wasnosignificantdifference
intheorganismsisolatedin
eithergroup(Table3).

Theantibioticsensitivityofthe
isolatedorganismswasana
lyzedbytheKirbyBauerdisk
diffusionmethod.Theisolates
wereconsideredresistant,
intermediate,orsusceptibleto
anantibioticbasedonthezone
ofinhibition(HiMedia
LaboratoriesPvt.Ltd.,
Bombay,India).Itshowedthat
100%samplesof
Staphylococcus,Streptococcus,
andPseudomonasspecieswere
sensitivetomoxi

Sharma et al Moxifloxacin 0.5% in Nonperforated Bacterial Corneal Ulcers

Table 1. Demographic and Baseline

Characteristics

No. enrolled
110

108

Group A:

Age (yrs)
P

Fortified
Group B:

29
24
(21.8)
Antibiotics
Moxifloxacin

30
(27.8)

Value

3049
41
(37.3)
45
(41.7)
0.33

5069

Left

33

60

(30)

(54.5)

27

66

(25)

(61.1)

7090

Socioeconomic status

12
(10.9)
06
(5.6)

Eye
Rural
54
(49.1)
30
(27.8)

Right

Semiurban

50

27

(45.5)

(24.5)

42

33

(38.9)

(30.6)

0.32

0.004

Urban
29
(26.4)
45
(41.7)

Systemic factor

Inpatient
15
(13.6)
16
(14.8)
0.80

Outpatient
Absent

95

104

(86.4)

(94.5)

92

81

(85.2)

(75)
0.00
Epithelial defect size

Present
06
(5.5)
27
(25)

Type of admission

(diameter in mm)

Contact lens use

36
(32.7)
48
(44.4)
Mean
4.2 2
4.41 1.5
0.22
Eye rubbing

Range
0.58
1.57.2

0
12
(11.1)

Prestudy pathologic features

Home-based medication
9
(8.2)
9
(8.33)
0.00

Trauma

Lagophthalmos

59

(53.6)

(2.7)

24

(22.2)

(8.33)

Corneal grafts

0
6
(5.6)

Fortified
Group B:

Pre-existing viral keratitis

3
(2.7)

Antibiotics
Moxifloxacin
Total

Organism
(n 91)
SD standard deviation.

(n 86)
(n 177)
Value

floxacin.AlltheisolatesofPseudomonas
species,Proteusmirabilis,andKlebsiella
speciesweresensitivetotobramycin.In
comparison,sensitivitytocefazolinwasseen
in90.6%isolatesofcoagulasenegative
Staphylococcus,76.6%isolatesofSaureus,
and45.5%isolatesofPaeruginosa(Table4).

Table 3. Organism Isolated from the

Corneal Ulcer (n 177)

Group A:

Staphylococcus epidermidis
45

(40.9)

(0.9)

52

05

(48.2)
97
Proteus mirabilis
14
Staphylococcus aureus

(12.7)

21

05

(19.1)

(4.6)

23

19

(21.3)
44

Pseudomonas aeruginosa

The numbers in the brackets indicate the

percentage of the cases.

06
(5.45)
05
(4.6)
11
0.24

Streptococcus pneumoniae
01
(0.91)

similar,andtherewasnosignificant
differenceinthe2groups(P0.065).No
seriouseventsdirectlyattributabletotherapy
werereportedduringthestudy.Percentage
healingdifferencewascalculatedtobe0.33
(95%CI,10.04to10.7)andadjusted
percentagedifference(adjustedfor
socioeconomicstatus,prestudypathologic
features,andpresenceofsystemicfactor)was
foundtobe1.58(95%CI,9.66to12.83)at3
months.Itwasfoundtobestatistically
insignificant(Table5andFig1).

00
(0)
01

Klebsiella species

Themeanlogarithmoftheminimumangleof
resolutionbestcorrectedvisualacuitiesin
groupAandgroupBatthetimeof
presentationwere1.590.44and1.550.46,
respectively(P0.50).Attheendof3months,
themeanlogarithmoftheminimumangleof
resolutionbestcorrectedvisualacuitieswere
comparableinthe2groups,thatis,1.30.51
ingroupAand1.340.53ingroupB(P0.88).

04
(3.6)
01

Twentycaseseachinboththegroups
worsened(P0.78).Therewasnodifference

intermsofmeanage(P0.29)or
socioeconomicstatus(P0.52)inthe
worsenedcasesbetweenthe2groups.All
ulcersthatworsenedwiththerapyingroupA
and80%(16/20)ofulcersingroupB
extendeddeeperthanthemidstroma,and

mostoftheseulcersdemonstratednegative
cultureresults(14/20ingroupAand16/20in
groupB).However,achangeintherapy
guidedbyrepeatmicrobiologicexamination
ledtoresolutionofulcersinthesecases,so
thattherapeutickeratoplastywasrequiredin
2casesingroupAandin1caseingroupB.

Outcome

Antibiotics
Moxifloxacin

Acompleteresolutionofkeratitisandhealing
ofulceroccurredin178(81.6%)patientsat3
months.Ofthese,90patients(81.8%)werein
groupAand88patients(81.4%)werein
groupB.Worseningofulcerwasseenin
18.2%ofcasesingroupAandin18.5%of
casesingroupB.Meantimeto
epithelializationwas

Total

Gram stain
(n 110)
(n 108)
(n 218)

Table 2. Microbiologic Analysis of

Corneal Scraping Samples

Value

Group A:

Fortified

Gram-positive cocci

Group B:

27
(24.5)
33

(30.6)
60
(27.5)

Values provided as n (%).

Gram-negative bacilli

Discussion

07
(6.4)
06
(5.6)
13
(5.9)
0.6

Total stain negative

76
(69.1)
69
(63.9)
145
(66.5)

1175

Thestandardtreatmentofmicrobial
keratitisconsistsofacombinationof
fortifiedtopicalantibioticsorfluoroquino
lones.Itgenerallyisadvocatedthatfor
nonsevereulcersthatarenotthreatening
thevisualaxis,fluoroquinolonesare
preferredovercombinationtherapy,
whereasincasesofseverebacterialulcers
threateningthevisualaxis,combination
therapywithfortifiedantibioticsis
preferred.Therearefactorsfavoring
monotherapy,suchaseaseofprocurement
ofmedicine,simplicityofapplicationand
10

storage,andlesschanceoftoxicity. With
theadventofnewerfourthgeneration
fluoroquinoloneswithenhancedgram
positivecoveragewhileretainingefficacy
againstgramnegativeorganisms,therehas
beenarenewedinterestinnewer
generationfluoroquinolonemonotherapy
1823

forbacterialkeratitis.
Thishasbeen
accomplishedbysubstitutionofthe
methoxygroupatposition8ofthe
quinolonering,whichhelpsin
simultaneousinhibitionofbothDNA
gyraseandtopoisomerase4ingram

Ophthalmology Volume 120, Number 6, June 2013

Table 4. In Vitro Antibiotic Sensitivity of Bacteria Isolated from Culture Samples

Type of Organism
Cefazolin
Tobramycin
Moxifloxacin
Ciprofloxacin
Ofloxacin
Gatifloxacin

Staphylococcus epidermidis
87/96
(90.6%)
94/96
(97.9%)
96/96
(100%)
93/95

(97.8%)
92/96
(95.8%)
94/96
(97.9%)
Staphylococcus aureus
33/43
(76.7%)
42/43
(97.7%)
43/43
(100%)
40/42
(95.2%)
39/43
(90.7%)
39/43
(90.7%)
Pseudomonas aeruginosa
5/11
(45.5%)
11/11
(100%)
11/11
(100%)
9/11
(81.8%)
8/11
(72.7%)
9/11
(81.8%)
Proteus mirabilis
1/5
(20%)
5/5

(100%)
4/5
(80%)
4/5
(80%)
4/5
(80%)
5/5
(100%)
Klebsiella species
1/1
(100%)
1/1
(100%)
1/1
(100%)
1/1
(100%)
1/1
(100%)
1/1
(100%)
Streptococcus pneumonia
13/18
(72.2%)
17/18
(94.4%)
18/18
(100%)
16/17
(94.11%)
17/18
(94.4%)
17/18
(94.4%)

Monotherapywithciprofloxacinandofloxacinwerestudiedin

positivebacteria.Thisnotonlyincreasestheefficacyofthe
actionofmoxifloxacinandgatifloxacinbutalsoreduces
theriskofresistancebecauseconcomitantmutationsin
bothgenesarelesslikelytooccurthanthesinglemutation
requiredfordevelopingresistancetoolderfluoroquinolo
nes.Thisstructuralmodificationalsodecreasesthesuscep
tibilitytoeffluxthedrugfromthebacterialcell,thereby
reducingriskofresistancedevelopment.

1923

Thepointssupportingcombinationfortifiedantibiotic
therapyarebettercoverageofgrampositiveandgram
negativeorganismsandlesschanceofdevelopmentof
antibioticresistance.Fortifiedantibioticshavethe
disadvantagethattheyneedtobepreparedundersterile
conditionsatapharmacyforuse.Concernshavebeen
expressedabouttheirshelflife,appropriatemethodof
storage,andthedurationforwhichtheycanbeusedsafely
2427

beforereplacement.
Fortifieddropsalsohavethe
theoreticalriskofthefirstdrugbeingwashedawayifboth
themedicinesareappliedsimultaneously.Using2drugsas
acombinationmayenhanceoculartoxicityandmay
preventreepithelialization.

2830

thepastandwerefoundtobeequallyeffective.

1014

Ina

29

studybyGangopadhyayetal, monotherapywith
fluoroquinoloneeyedropsledtoshorterdurationofintensive
therapyandashorterhospitalstaycomparedwithcombined
fortiestherapy(tobramycinandcefazolin).However,serious
complicationswereencounteredmorecommonlyinthe
fluoroquinolonegroup,suchascornealperforation,
evisceration,orenucleationoftheaffectedeye.Thelimitation
29

ofthisstudywasthatitwasretrospective. Thereareonly2
prospective,randomized,controlledclinicaltrialscomparing
theefficacyofmoxifloxacinwithcombinationfortified
therapyinbacterialkeratitis.

31,32

Inapilotprospectivestudycomparingmoxifloxacin
(0.5%),gatifloxacin(0.3%),andfortifiedtobramycin
(1.33%)pluscefazolin(5%)with20patientswithcorneal
31

ulcersineachgroup,similaroutcomeswereseen. How
ever,thesamplesizeofthisstudywassmallandthepower

ofthestudywasonly32%.Theonlyotherrandomized,
controlledclinicaltrialcomparingmoxifloxacinandcom
32

binationtherapywascarriedoutbyConstantinouetal. They
comparedmoxifloxacin(1%),ofloxacin(0.3%),andfortified
tobramycin(1.33%)pluscefazolin(5%)andfoundsimilar

ratesofhealingofcornealulcers.Therewere3differencesin
thestudyprotocolcomparedwiththepresentstudy.The
presentstudyusedcommerciallyavailablemoxifloxacin
hydrochloride0.5%(Vigamox;Alcon),unlikethestudyby
Constatinouetal,inwhich1%moxifloxacinthatwas
reconstitutedatapharmacywasused;theavailabilityofthis
commercialpreparationobviatestheneedforahospital
pharmacytopreparethedrug.InthestudybyConstatinouet
al,theinitialtherapywasceasedat1weekandapreservative
freeprophylacticantibioticsuchaschloramphenicolointment
wasusedsubsequently,ifrequired.However,inthepresent
study,becausepreservativefreemoxifloxacinwasbeing
used,itwascontinueduntilcompletehealingoccurred.
Furthermore,inthisstudy,notopicalcorticosteroidswere
used,whichwereusedinthestudybyConstatinouetalasthe
ulcerwasresolving.Ithasbeendemonstratedamplyinthe
availablerandomizedclinicaltrialsthattopicalcorticosteroids
maynothelpinenhancingtherateofhealingincasesof
resolvingkeratitis.

33,34

Table 5. Outcomes of Patients with Corneal Ulcer*

Group A: Fortified
Group B:
% Difference in
Adjusted Difference

Antibiotics
Moxifloxacin
Healing (95%
(95% Confidence

(n 110)
(n 108)
Confidence Interval)
Interval)

Theargumentagainstfluoroquinolonemonotherapyisthat
althoughtheseagentsareconsideredveryeffectiveandsafe,
resistanceisboundtooccuriftheyareusedindiscriminately,
andafewcasesofmoxifloxacinandgatifloxacinresistance
alreadyareemerging,especiallyincasesofinfectious
3540

keratitisoccurringafterrefractivesurgery
;however,their
judicioususeinanappropriatesettingmaybejustified.
Furthermore,poorpatientsfromruralareasoftenare
uneducatedandhavepooraccesstotertiarycarehospitalsor
pharmacy.Theymaynotbeabletostorethefortified
medicationatacooltemperaturetomaintainitsshelflife.The
combinationtherapymayenhancethecostoftreatmentas
well.Itmaybedifficulttoexplainthemethodofsequential
applicationoffortifiedtopicalmedicationtouneducated
patients,andinappropriateapplicationmaynullifythe

Not healed at 3 mos

20 (18.2)
20 (18.5)
0.33 ( 10.04 to 10.7)
1.58 ( 9.66 to 12.83)
Healed at 3 mos
90 (81.8)
88 (81.4)

*Adjusting for socioeconomic status, risk factors, and systemic factors.

1176

Sharma et al Moxifloxacin 0.5% in Nonperforated Bacterial Corneal Ulcers

epitheliotoxic.Furtherstudiesare
requiredtoevaluatetheroleof
moxifloxacin0.5%inperforatedcorneal
ulcers.

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WhitcherJP,SrinivasanM,UpadhyayMP.
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PolackS,BrookerS,KuperH,etal.Mapping
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WorldHealthOrgan2005;83:9139.

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moxifloxacin and those receiving fortified
antibiotics.

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Compliancealsoisdifficulttomaintainwith
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Toconclude,thisstudydemonstrated
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Footnotes and Financial Disclosures

Originallyreceived:April16,
2012.

Finalrevision:October14,2012.

Accepted:November8,2012.

Availableonline:February15,
2013.
Manuscriptno.2012
546.

RajendraPrasadCentrefor
OphthalmicSciences,AllIndia
InstituteofMedicalSciences,
NewDelhi,India.

DepartmentofBiostatistics,All
IndiaInstituteofMedical
Sciences,NewDelhi,India.

CentreforEyeResearch
Australia,Universityof
Melbourne,RoyalVictorianEye
andEarHospital,Melbourne,
Australia.

FinancialDisclosure(s):

Theauthor(s)havenoproprietary
orcommercialinterestinany
materialsdiscussedinthisarticle.

SupportedbytheAllIndia
InstituteofMedicalSciences,
NewDelhi,India.

Correspondence:

NamrataSharma,MD,Rajendra
PrasadCentreforOphthalmic
Sciences,AllIndiaInstituteof
MedicalSciences,NewDelhi
110029,India.Email:
namrata.sharma@gmail.com.

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