Safety of undiluted intracameral moxifloxacin without postoperative topical antibiotics in cataract surgery

Abstract

The objective of this study is to evaluate the safety of undiluted 0.5 % intracameral moxifloxacin for postoperative endophthalmitis prophylaxis in cataract surgery patients without the use of additional postoperative topical antibiotics. All phacoemulsification cataract surgeries performed by a single surgeon (B.A.) at the John A. Moran Eye Center from June 2012 to May 2015 were reviewed retrospectively. From June 2012 to April 2014, patients were given topical 0.5 % moxifloxacin postoperatively. From May 2014 to May 2015, all patients were given moxifloxacin intracamerally with no antibiotics postoperatively. The follow-up period was 1 month after surgery. Preoperative visual acuity and postoperative visual acuity, corneal edema, and anterior chamber reaction were recorded and compared between the two groups. 384 cataract surgeries were performed during the study period. None of the 384 eyes in the study developed endophthalmitis. Of those 384 eyes, 222 were included in the study for analysis based on the inclusion and exclusion criteria. 131 were part of the topical antibiotic group and 91 were part of the intracameral group. The differences in uncorrected visual acuity at 1 day postoperatively (p = 0.595) and best corrected visual acuity at 1 month postoperatively (p = 0.099) were not statistically significant. Differences in corneal edema (p = 0.370) and anterior chamber reaction (p = 0.069) at 1 day postoperatively and corneal edema (p = 0.512) and anterior chamber reaction (p = 0.512) at 1 month postoperatively were also not statistically significant. Undiluted 0.5 % moxifloxacin can be safely injected intracamerally following cataract surgery without additional postoperative antibiotic prophylaxis to prevent endophthalmitis without adverse effects on patient outcomes.

Bilateral acute iris transillumination following systemic administration of antibiotics

“…To date there have been no reports in the literature of ocular adverse effects on the iris epithelium following topical use of moxifloxacin. Moreover, toxicity studies have demonstrated a good safety profile of topical and intracameral use of moxifloxacin [14][15][16]. In addition, despite the high concentration of moxifloxacin following intravitreal administration, the rapid clearance of the drug within the first 12 h accounts for the lackof adverse reactions [17].…”

Re: Schwartz et al.: Intracameral antibiotics and cataract surgery: endophthalmitis rates, cost, and stewardship ( Ophthalmology . 2016;123:1411-1413)

“…Second, there have now been 3 papers 2–4 from the United States showing that use of intracameral moxifloxacin without postoperative topical antibiotics does not result in a higher endophthalmitis rate. There have been several more papers from around the world demonstrating the same point (that postoperative topical antibiotics are unnecessary in routine, uncomplicated cataract surgery) with intracameral cefuroxime.…”

Endophthalmitis prophylaxis in cataract surgery

“…It will be interesting to watch if a routine use of intracameral antibiotic would reduce or eliminate routine use of postoperative topical antibiotic. [ 10 ] This will be very beneficial to people living in the developing countries where the cost and compliance are critical issues. In this issue, the rationale and the current evidences of antibiotic prophylaxis in cataract surgery are reviewed.…”