Intracameral moxifloxacin minimizes risk of endophthalmitis

This is the first prospective randomized clinical trial assessing the safety and efficacy of intracameral moxifloxacin for preventing post-cataract endophthalmitis.

Study design

This study was conducted in Brazil and comprised 3,640 patients. At the end of cataract surgery, participants were randomized to receive an intracameral injection of 150 ug of undiluted 0.5% moxifloxacin (n=1,818) or no medication (n=1,822) and followed for 6 weeks postop.

Outcomes

At 6 weeks, the incidence of endophthalmitis was significantly lower in the moxifloxacin group than in controls (0.05% vs. 0.38%; P=0.035). There were no differences in corrected distance visual acuity, endothelial cell density, IOP or central corneal thickness. The safety parameters of both groups were similar; no ocular or systemic adverse events were noted.

Limitations

As with every endophthalmitis study, the study sample size is the major limitation. With such a rare disease, it is difficult to ascertain much data on the disease and the true impact of the treatments. This study also had a low rate of culture-proven endophthalmitis. PCR tests were not used but could have been helpful.

Clinical significance

This study should give surgeons belief in the intracameral drug delivery system for prevention of endophthalmitis. Endophthalmitis is a vision-threatening disease, and these findings support the use of intracameral moxifloxacin as a safe and effective way to reduce the risk of infection.