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  • Large study confirms moxifloxacin reduces risk of endophthalmitis

    Cataract/Anterior Segment, Comprehensive Ophthalmology

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    A retrospective analysis of more than 600,000 cataract surgeries at an Indian regional eye care system found that use of intracameral (IC) moxifloxacin prophylaxis significantly lowered rates of postoperative endophthalmitis.

    Study design

    This study included patients who underwent manual small incision extracapsular cataract extraction (MSICS) or phacoemulsification at the 10 regional Aravind Eye Hospitals. All patients were treated between January 2014 and May 2016. The initial 302,815 eyes did not receive any IC prophylactic antibiotics, whereas the remaining 314,638 eyes received routine administration of 0.1 ml of moxifloxacin 0.5%. All subjects received preoperative ofloxacin drops, povidone prep, and postoperative gatifloxacin-dexamethasone drops.

    Outcomes

    The overall incidence of endophthalmitis decreased from 0.07% to 0.02% following adoption of a standardized IC moxifloxacin protocol (0.5 mg/0.1 ml). Subanalyses revealed approximately 3.5- and 7-fold decreases in infection rates among sutureless MSICS and phacoemulsification eyes, respectively (both P<0.001).

    IC moxifloxacin also significantly lowered the rate of endophthalmitis among patients who experienced posterior capsule rupture, a known risk factor (0.21% vs. 0.48%, P=0.03).

    Limitations

    While the study was not randomized, this was a consecutive series involving hundreds of thousands of patients. The cohort included surgeries by multiple surgeons at multiple hospitals, but this limitation was offset by standardized protocols within the Aravind Eye Care System.

    Clinical significance

    This is one of the most convincing studies to date demonstrating the efficacy of intracameral antibiotics in reducing postoperative endophthalmitis. At a center with already low baseline rates of endophthalmitis, the findings show a significant reduction after the addition of moxifloxacin.

    Because a large proportion of the cohort were at high risk for infection, the authors believe the findings support the use of IC moxifloxacin, especially in countries where IC cefuroxime is commercially unavailable.