Draw 0.1mL of the solution (which is 0.5mg/0.1mL concentration)
directly from the bottle, and it's ready to inject. Note that other brand-
ed or generic multi-use moxifloxacin formulations are not appropriate
for this purpose.
Alternatively, if the surgeon prefers to inject a 0.25mg/0.1mL concen-
tration, dilute the Vigamox 2-1 with BSS. A third approach, developed
and reported by Steve A. Arshinoff, MD, FRCSC, associate professor
in the Department of Ophthalmology & Vision Sciences at the
University of Toronto, is to place the entire 3mL of Vigamox into a
syringe and add 7mL of BSS. That results in a concentration of
0.15mg/0.1mL, which lets the surgeon inject more than 0.1mL, essen-
tially replacing most of the aqueous with drug, without worrying that
the concentration will be too high.
An important reminder: You can't use a multidose bottle for more
than one patient, so you must either discard the unused portion or
send the excess medication home with the patient, a sensible move if
the patient will also need topical Vigamox to prevent, for example, a
corneal infection following a limbal-relaxing incision, notes Sydney L.
Tyson, MD, MPH, the CEO of Eye Associates SurgiCenter of Vineland
(N.J.).
Using Vigamox for intracameral injection can get expensive, particu-
larly if you waste most of each bottle. Undiscounted retail prices per
3mL bottle can range from $35 to $200. A no-cost option: Have the
surgeon prescribe Vigamox for the patient, who then brings the bottle
in on the day of surgery.
Now that intracameral injection is more popular, more compound-
ing pharmacies are offering single-dose moxifloxacin. "This is avail-
able in unit vials containing 1mL, one vial per patient," says E. Helen
Smith, RN, LHRM, CHOP, administrator at Largo Ambulatory Surgery
Center at The Eye Institute of West Florida. "We currently pay $20 per
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