LETTERS TO THE JOURNAL Deposition of Topical Ciprofloxacin to Prevent Re-epithelialization of a Corneal Defect Anastasios J. Kanellopoulos, M.D., Frederick Miller, M.D., and John R, Wittpenn, M.D. Department of Ophthalmology, Stony Brook Univer- sity Hospital, State University of New York at Stony Brook (A.J.K., J.R.W.); Nassau County Medical Cen- ter, Division of Ophthalmology (A.J.K.); and Depart- ment of Pathology, Stony Brook University Hospital, State University of New York at Stony Brook (F.M.). Inquiries to A.]. Kanellopoulos, M.D., 306 E. 71st St., Apt. 2B, New York, NY 10021. Fluoroquinolones have altered the armamen- tarium of topically administered ocular anti- biotics. Topical ciprofloxacin is now an accept- ed agent for the treatment of infectious ulcerative keratitis. 1 Frequent application of ciprofloxacin may cause a white precipitate on the ulcerated surface. We treated a patient who developed a firmly adherent plaque rather than a precipitate after treatment with topical cipro- floxacin. An 83-year-old woman underwent penetrat- ing keratoplasty for pseudophakic bullous ker- atopathy. Postoperatively, the graft cleared normally but epithelialization was slow secon- dary to reduced tear production. At the two- month postoperative visit, however, she had a broken suture, a small epithelial defect, and an associated suture abscess. There was a marked inflammatory reaction in the eye as well as THE JOURNAL welcomes letters that describe unusual clinical or pathologic findings, experimental results, and new instruments or techniques. The title and the names of all authors appear in the Table of Contents and are retrievable through the Index Medicus and other standard indexing services. Letters must not duplicate data previously published or submitted for publication. Each letter must be accompanied by a signed disclosure statement and copyright transfer agreement published in each issue of THE JOURNAL. Letters must be typewritten, double-spaced, on 8 Vi X 11-inch bond paper with 1 Vii-inch margins on all four sides. (See Instructions to Authors.) An original and two copies of the typescript and figures must be sent. The letters should not exceed 500 words of text. A maximum of two black-and-white figures may be used; they should be cropped or reducible to a width of 3 inches (one column). Color figures cannot be used. References should be limited to five. Letters may be referred to outside editorial referees for evaluation or may be reviewed by members of the Editorial Board. All letters are published promptly after acceptance. Authors do not receive galley proofs but if the editorial changes are extensive, the corrected typescript is submitted to them for approval. These instructions markedly limit the opportunity for an extended discussion or review. Therefore, THE JOURNAL does not publish correspondence concerning previously published letters. circulating hemorrhage from the extensive in- traocular procedures performed at the time of the keratoplasty. Scraping was not performed because the defect was small. The suture ab- scess was treated empirically with topical cipro- floxacin every 30 minutes for 24 hours, then every 30 minutes while the patient was awake. After three days the medication was reduced to every two hours because the infiltrate had im- proved but the defect had enlarged with forma- tion of precipitate in the ulcer bed. At 11 days the defect appeared to be healing, but persis- tent deposits remained. Over the next two months treatment with ciprofloxacin was re- duced to twice a day as the infiltrate completely Fig. 1 (Kanellopoulos, Miller, and Wittpenn). The initial corneal graft shows the dense superficial white plaque before repeat grafting. 258