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  • Large study bolsters evidence supporting prophylactic moxifloxacin

    Cataract/Anterior Segment, Comprehensive Ophthalmology

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    Review of: Endophthalmitis reduction with intracameral moxifloxacin in eyes with and without surgical complications: Results from 2 million consecutive cataract surgeries

    Haripriya A, Chang D, Ravindran R, et al. Journal of Cataract & Refractive Surgery, September 2019

    This is one of the largest studies to investigate the use of prophylactic intracameral moxifloxacin for preventing postoperative endophthalmitis.

    Study design

    Investigators retrospectively analyzed more than 2 million consecutive phacoemulsification and manual small-incision (MSICS) procedures performed in Aravind Eye Hospitals in India during an 8-year period. The primary outcome was rate of postoperative endophthalmitis in uncomplicated and complicated eyes with and without intracameral moxifloxacin prophylaxis (ICMP).

    Outcomes

    The overall rate of endophthalmitis significantly declined from 0.07% to 0.02% with intracameral moxifloxacin, regardless of the type of surgery. Moxifloxacin was particularly beneficial in eyes with complications such as posterior capsule rupture, significantly cutting infection rates in both the MSICS (0.54% vs. 0.26%) and phaco (0.29% vs. 0.06%) groups when compared with untreated eyes.

    Limitations

    This study is retrospective, which introduces variables that wouldn't have been in a prospective randomized controlled trial. The differences in surgical techniques between surgeons is also a limiting factor.

    Clinical significance

    This study adds more evidence that highlights the usefulness of intracameral antibiotics for reducing endophthalmitis risk. These data are convincing that intracameral moxifloxacin is a good antibiotic choice for preventing postoperative endophthalmitis.