The Effectiveness of Intracameral Moxifloxacin Endophthalmitis Prophylaxis for Trabeculectomy

Mitchell, William; Tom, Lisa; Durai, Indira; Rajagopal, Sindhushree; Vimalanathan, Menaka; Venkatesh, Rengaraj; Srinivasan, Kavitha; Zebardast, Nazlee

doi:10.1016/j.ogla.2020.07.008

Cited by 4 publications

(11 citation statements)

References 35 publications

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“…Other noninfective postoperative complications were statistically similar regardless of the use of IC moxifloxacin. However, the rate of AC reformation was significantly higher after the use of IC moxifloxacin than it was without IC moxifloxacin (0.47% vs. 0.28%, P <0.001) 102. Though there is no clear explanation for the increased rate of AC reformation with IC moxifloxacin, this cannot be written off as pure coincidence.…”

Section: Ic Antibiotics and Glaucoma Surgerymentioning

confidence: 88%

“…The decision to add IC antibiotics to a surgeon’s treatment paradigm must be thoughtful and supported by sound data. Recent studies support the role of IC antibiotics to reduce endophthalmitis in trabeculectomy 43,102. No current studies examine the role of IC antibiotics in GDI surgeries, which are increasing in frequency 2.…”

Section: Discussionmentioning

confidence: 99%

“…This retrospective review compared endophthalmitis rates in the former time period to the later time period, and it assumed that any difference in the rate of endophthalmitis was due to the introduction of IC antibiotics and not due to any other potential advances in surgical technique. Topical ofloxacin was administered to all patients preoperatively and for 15 days postoperatively 102…”

Section: Ic Antibiotics and Glaucoma Surgerymentioning

confidence: 99%

“…67 On review of the literature as of December 2020, only 2 studies examined the role of IC antibiotics specifically for glaucoma surgery. 43,102 These 2 studies will be discussed in-depth, and the findings will be evaluated critically.…”

Section: Ic Antibiotics and Glaucoma Surgerymentioning

confidence: 99%

“…However, the rate of AC reformation was significantly higher after the use of IC moxifloxacin than it was without IC moxifloxacin (0.47% vs. 0.28%, P<0.001). 102 Though there is no clear explanation for the increased rate of AC reformation with IC moxifloxacin, this cannot be written off as pure coincidence. More data is needed to better understand the etiology and impact of this one increased complication rate.…”

Section: Ic Antibiotics and Glaucoma Surgerymentioning

confidence: 99%

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Intracameral Antibiotics and Glaucoma Surgery

Marando¹,

Neeson²,

Valle³

2022

International Ophthalmology Clinics

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surgery. 21 Despite these statistics, there is no consensus in the glaucoma community regarding IC antibiotic prophylaxis. ' Infection in Glaucoma Surgeries Timing of Infection IC antibiotics only have utility in preventing acute postoperative endophthalmitis. Under ideal conditions, IC antibiotics maintain a minimum inhibitory concentration for up to ∼30 hours in the anterior chamber (AC). 22 In the literature, acute infections are defined as occurring <4 to 6 weeks following surgery, whereas late infections occur > 6 weeks postoperatively. Late infections are more common than acute infections following trabeculectomy 23 and are often associated with bleb leaks. 24,25 In one study, only 15% (10/68) of cases of bleb-associated endophthalmitis (BAE) occurred within 1 month of surgery. 26 Late infections are also more common than acute infections following GDI surgery and are often associated with late tube exposures. 27,28 Since MIGS are relatively new, and the devices vary, it is unclear whether endophthalmitis will more often be acute (like after traditional cataract surgery) or late (like after traditional glaucoma surgery). This will probably vary based on whether a conjunctival bleb is formed, like in the case of the XEN Gel Stent (XGS) (Allergan, Abbvie Company, Irvine, CA, USA), and whether corneal incisions are made, which can act as a gateway for periocular bacteria in the immediate postoperative period. Even though late infections tend to be common, acute infections still confer significant morbidity for glaucoma patients.In fact, acute postoperative endophthalmitis occurs 3 times as often following glaucoma surgery than cataract surgery according to data from the Intelligent Research in Sight (IRIS) registry from 2013 to 2017. Before the widespread adoption of IC antibiotics for cataract surgery, the rate of acute endophthalmitis was 0.08% for cataract surgery and 0.12% for glaucoma filtering surgeries. 29 After evidence supporting IC antibiotics in cataract surgery emerged, the rate of acute endophthalmitis halved to 0.04% following cataract surgery alone, but remained at 0.12% following cataract surgery combined with glaucoma surgery. This may be because IC antibiotics have not been studied in the setting of glaucoma surgery, though this has yet to be determined. 21 Since, theoretically, only acute infections are prevented by the use of IC antibiotics, Table 1 summarizes the estimated incidence of overall and acute infection for each of the major glaucoma surgeries. Rate of Infection After TrabeculectomyTrabeculectomy is the second most common glaucoma surgery following MIGS. 1,2 The exact rate of infection after trabeculectomy is 126 ' Marando et al

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Section: Ic Antibiotics and Glaucoma Surgerymentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Ic Antibiotics and Glaucoma Surgerymentioning

confidence: 99%

Section: Ic Antibiotics and Glaucoma Surgerymentioning

confidence: 99%

Section: Ic Antibiotics and Glaucoma Surgerymentioning

confidence: 99%

See 3 more Smart Citations

Intracameral Antibiotics and Glaucoma Surgery

Marando¹,

Neeson²,

Valle³

2022

International Ophthalmology Clinics

View full text Add to dashboard Cite

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Reply

Sabharwal,

Dun,

Woreta

2024

Ophthalmology

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Susceptibility of Ocular Surface Bacteria to Various Antibiotic Agents

Ghita,

Iliescu,

Ghita

et al. 2023

Preprint

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Periodic assessment of bacterial contamination is necessary as it allows proper guidance in cases of eye infections through the use of appropriate antibiotics. Due to the extensive use of antibiotic treatment, most of the contamination flora is resistant to the usual ophthalmic antibiotics. The present study shows an updated picture of the susceptibility of Gram-positive and Gram-negative bacteria found on the ocular surface to the most commonly used antibiotic agents in patients undergoing cataract surgery. A total of 993 patients were included in the study with ages between 44 and 98 years old. Conjunctival culture was collected 7 days before cataract surgery. The response of Gram-positive and Gram-negative bacteria to various antibiotic classes like glycopeptides, cephalosporins, carbapenems, fluoroquinolones, aminoglycosides, phenicols, tetracyclines, rifamycins, macrolides and penicillins was assessed. From the tested antibiotics, vancomycin had 97.8% efficacy on Gram-positive bacteria. In the cephalosporin category, we observed an increased resistance of the cefuroxime for both Gram-positive and negative bacteria. Antibiotics that have more than 90% efficacy on Gram-positive bacteria are: meropenem, imipenem, netilmicin, amikacin and rifampicin. On Gram-negative bacteria, we found 100% efficacy of all tested fluoroquinolones, aminoglycosides (except for tobramycin), doxycycline, azithromycin, clarithromycin and chloramphenicol. The current study illustrates patterns of increased resistance of certain bacteria present on ocular surface to some of the commonly used antibiotics in ophthalmological clinical practice. One such revealing example is cefuroxime, which has been highly used as an intracameral antibiotic for the prevention of bacterial endophthalmitis after cataract surgery.

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The Effectiveness of Intracameral Moxifloxacin Endophthalmitis Prophylaxis for Trabeculectomy

Cited by 4 publications

References 35 publications

Intracameral Antibiotics and Glaucoma Surgery

Intracameral Antibiotics and Glaucoma Surgery

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Susceptibility of Ocular Surface Bacteria to Various Antibiotic Agents

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