A study with more than 1.5 million cataract surgeries found that endophthalmitis rates lowered with the use of intracameral moxifloxacin prophylaxis.
Patients were then followed for 4 to 6 weeks postoperatively. There was a total of 1,541,867 cataract procedures during the 72- month study period, which were about half and half with or without intracameral moxifloxacin (766,660 eyes did not receive moxifloxacin, and 755,207 eyes did receive it).
The use of the intracameral moxifloxacin significantly decreased the endophthalmitis rate from 7 per 10,000 to 2 per 10,000, Dr. Haripriya said. This decrease occurred both with phacoemulsification and manual small-incision cataract surgery, the latter of which was performed more frequently. Intracameral moxifloxacin also helped to reduce postoperative endophthalmitis in eyes that had a posterior capsule rupture.
Although the posterior capsular rupture rate was similar in both groups that did and did not receive intracameral moxifloxacin (1.5% and 1.4%, respectively), use of the intracameral antibiotic was effective in significantly lowering endophthalmitis in these high-risk eyes with a posterior capsule rupture. Endophthalmitis was more common in eyes that had a secondary IOL.
When analyzing culture results, many were negative. Endophthalmitis due to coagulase negative Staphylococcus, which was the most common culture positive organism, was also much lower with the group that received moxifloxacin prophylaxis
This study has several strengths, according to Dr. Haripriya. It included a large number of patients, took place at a single hospital network, and universal standardized protocols were used. There also were more than 22,000 eyes that had posterior capsule rupture.
Aravind Haripriya, MBBS
E: [email protected]
This article was adapted from Dr. Haripriya’s presentation at the 2018 meeting of the American Academy of Ophthalmology. Dr. Haripriya has no related disclosures.
1. Daien V, Painaud L, Gillies MC, Domerg C, Nagot N, Lacombe, S, et al. Effectiveness and safety of an intracameral injection of cefuroxime for the prevention of endophthalmitis after cataract surgery with or without perioperative capsular rupture. JAMA Ophthalmol. 2016;134:810-816.
2. Herrinton LJ, Shorstein NH, Paschal JF, Liu L, Contreras R, Wintrhop KL, et al. Comparative effectiveness of antibiotic prophylaxis in cataract surgery. Ophthalmology. 2016;123:287-294.