Study: Intracameral moxifloxacin reduces endophthalmitis cases

A study with more than 1.5 million cataract surgeries found that endophthalmitis rates lowered with the use of intracameral moxifloxacin prophylaxis.

Reviewed by Aravind Haripriya, MBBS

Intracameral moxifloxacin was found to be a safe and effective prophylactic antibiotic to reduce endophthalmitis rates in both phacoemulsification and manual small-incision cataract surgery patients, according to a study presented by Aravind Haripriya, MBBS, Aravind Eye Hospital, Chennai, India.

The treatment also was shown to be effective in eyes that had posterior capsule rupture, leading Dr. Haripriya and the study’s coauthors to recommend using it in that particular subset of eyes, which are at higher risk for endophthalmitis. Dr. Haripriya cited studies that reported the overall postoperative endophthalmitis rate increases by 7- to 10-fold when posterior capsule rupture occurs.^1,2

Study timeline

The study done by Dr. Haripriya and co-researchers was a retrospective review of all cataract surgeries performed from 2012 to 2017 at 10 centers of Aravind Eye Hospital. The use of intracameral moxifloxacin began in August 2014 at one center and then expanded to the other nine centers over the following 6 months.

The intracameral moxifloxacin was ready to use, with no mixing or dilution required. It was available in a 1-ml vial, with each milliliter containing 5 mg of moxifloxacin. The dosing given was 0.5 mg/0.1 ml that was injected in the anterior chamber at the end of surgery.

Standardized operating room and sterilization protocols were used across all Aravind eye hospitals. Patients also received topical ofloxacin at 1 day before surgery and for 15 days after surgery.

“Topical povidone–iodine was used immediately prior to surgery to prep the periorbital area and the conjunctival cul-de-sac,” Dr. Haripriya said.

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

Study strengths

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.

Disclosures:

Aravind Haripriya, MBBS
E: haripriya@aravind.org
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.

References:

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.