Skip to main content

  • Endophthalmitis Reduction With IC Moxifloxacin Prophylaxis for Cataract Surgery

    By Lynda Seminara and selected by Stephen D. McLeod, MD
    Add to My Bookmarks

    Journal Highlights

    Ophthalmology, June 2017

    Download PDF

    Building on favorable findings of a single-center study, Haripriya et al. instituted routine intracameral (IC) moxifloxacin prophylaxis for all cata­ract surgeries performed in a network of regional eye hospitals in Southern India. Their subsequent study demon­strated that this prophylaxis reduced the rate of postoperative endophthal­mitis by 3.5-fold.

    In the expanded study, electronic health data were examined for all cata­ract surgeries (N = 617,453) performed in the Aravind Eye Care System during a 29-month period. Endophthalmitis rates before and after institution of IC moxifloxacin prophylaxis were deter­mined for all eyes and separately for eyes that underwent phacoemulsifica­tion, eyes treated by manual small-incision cataract surgery (M-SICS),and cases complicated by posterior capsular rupture.

    IC moxifloxacin prophylaxis was used in 51% of eyes (314,638) and not used in 49% (302,815). The rate of endophthalmitis was significantly lower for prophylaxis-treated eyes (0.02% vs. 0.07%; p < .001). Among the 194,252 eyes that underwent phacoemulsification, the endophthalmitis rate was 0.01% with moxifloxacin prophylaxis and 0.07% without it (p < .001). The respective rates of endoph­thalmitis for the 414,657 eyes treated by M-SICS were 0.02% and 0.07% (p < .001). Among eyes with capsule rupture, the rate of endoph­thalmitis was significantly lower for those with pro­phylaxis (0.21% vs. 0.48%; p = .034). IC moxifloxacin was not associated with any adverse events.

    M-SICS accounts for a large volume of cata­ract surgery in developing countries. The link between vancomycin and hemorrhag­ic occlusive retinal vasculitis, coupled with the unavailabil­ity of IC cefuroxime in many countries, emphasizes the need for safe and effective prophylactic antibiotics for cataract surgery.

    The authors concluded that prophy­laxis with IC moxifloxacin is safe and reduces the rate of endophthalmitis significantly. Moreover, IC moxifloxacin proved beneficial for eyes complicated by posterior capsule rupture, and there­fore should be considered in such cases.

    The original article can be found here.