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Clinical trial suggests safety of unpreserved levofloxacin


Intracameral injection of cefuroxime, moxifloxacin decrease risk of endophthalmitis

A clinical trial suggests that intracameral unpreserved levofloxacin 0.5% is a viable option for prophylaxis of endophthalmitis after cataract surgery.

Reviewed by Harvey S. Uy, MD

Results of a prospective, double-masked, randomly selected comparative trial suggest that intracameral unpreserved levofloxacin 0.5% (Oftaquix, Santen) is a viable option for prophylaxis of endophthalmitis after cataract surgery, said Harvey S. Uy, MD.

The study included 114 eyes that received intracameral injection of unpreserved levofloxacin 0.5 mg/0.1 mL or unpreserved moxifloxacin 0.5 mg/0.1 mL (Vigamox, Alcon Laboratories) after uncomplicated cataract surgery with IOL implantation.

There were no statistically significant differences between study groups in the outcomes analyses that considered various safety endpoints, said Dr. Uy, clinical associate professor of ophthalmology, University of the Philippines, and medical director, Peregrine Eye and Laser Institute in Makati, Philippines.

“There is growing evidence that intracameral injection of cefuroxime and moxifloxacin decrease the risk of endophthalmitis after cataract surgery,” he said. “The use of these antibiotics may be limited in certain situations, and so there is a need for alternatives that may be more widely accessible.”

Dr. Uy noted that while the study was not powered to show a difference in efficacy between moxifloxacin and levofloxacin for preventing endophthalmitis, “the results indicate that the two fluoroquinolones are equally safe when used as antibacterial prophylaxis after cataract surgery.”

RELATED: Novel artificial cornea option to transplantPatients were randomly selected 1:1 into two groups. In each case, the antibiotic was withdrawn in the operating room from the commercially available multidose bottle containing product marketed for topical ophthalmic use.

Postoperatively, patients received the same medication regimen, which consisted of topical prednisolone acetate 1% and topical gatifloxacin.

They returned for follow-up after one day, seven days, and 30 days. Researchers used coherence tomography imaging to measure central subfield retinal thickness and macular volume, specular microscopy to measure endothelial cell density, and pachymetry to measure central corneal thickness prior to surgery and at postoperative visits. Changes from baseline at each follow-up visit were compared between the groups.

The patients receiving moxifloxacin and levofloxacin were well-matched in their baseline age and clinical characteristics, including cataract density. There were no statistically significant differences between the study groups in any of the outcome measures at any timepoint after surgery.

“There were also no significant adverse events in either study group, and no patient developed endophthalmitis or toxic anterior segment syndrome,” Dr. Uy noted. “Corneal edema was the most common adverse event and occurred similarly in both groups.”

Vancomycin has also been injected intracamerally to prevent endophthalmitis, Dr. Uy concluded. Reports of hemorrhagic occlusive retinal vasculitis limit the use of vancomycin for infection prophylaxis.

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Harvey S. Uy, MD
E: harveyuy@yahoo.com
This article was adapted from Dr. Uy’s presentation at the 2019 meeting of the American Society of Cataract and Refractive Surgery. Santen provided research funding for the study. Dr. Uy has no other relevant financial interests to disclose.

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