• Endophthalmitis Reduction With IC Moxifloxacin Prophylaxis for Cataract Surgery

    By Lynda Seminara and selected by Stephen D. McLeod, MD

    Journal Highlights

    Ophthalmology, June 2017

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    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.