Intracameral moxifloxacin 0.5% significantly reduces the incidence of endophthalmitis after cataract surgery compared with no intracameral antibiotic use, according to results from the largest randomized controlled trial to date, published in the Journal of Cataract and Refractive Surgery.
The multicenter study was conducted by investigators at the All India Institute of Medical Sciences and other tertiary eye centers in India. The researchers examined 30,000 cases (60,000 eyes) of phacoemulsification with intraocular lens implantation between January 2018 and June 2024.
The incidence of acute postoperative endophthalmitis was 0.02% in the moxifloxacin group (6 of 30,000 eyes) vs 0.05% in the control group (16 of 30,000 eyes), which the researchers characterize as a statistically significant difference (P =.04).
This corresponded to a 2.5-fold reduction in odds of infection with intracameral moxifloxacin. Both groups were comparable in baseline demographics, surgical techniques, and postoperative outcomes, including visual acuity, endothelial cell density, and central corneal thickness.
Intracameral moxifloxacin is safe and effective in preventing post-cataract surgery acute bacterial endophthalmitis.
With respect to complications, culture-positive infections accounted for 36% of all cases, with coagulase-negative Staphylococcus epidermidis the most common infection, followed by Pseudomonas aeruginosa and Staphylococcus aureus. Resistance rates were highest for ciprofloxacin (75%) and lowest for moxifloxacin (28.5%), highlighting the latter’s greater efficacy as a fourth-generation fluoroquinolone. At 3 months, 77% of eyes affected by endophthalmitis responded to treatment, although 18% developed phthisis, and one case in the control group progressed to panophthalmitis.
“Intracameral moxifloxacin is safe and effective in preventing post-cataract surgery acute bacterial endophthalmitis,” according to the research team, who add that no evidence of endothelial toxicity or excess postoperative inflammation was observed in eyes receiving intracameral moxifloxacin.
Study limitations include its nonblinded design involving participants randomized by nonmasked preoperative surgeons, nonmasked post-operative evaluators and study coordinators; and inclusion of cases performed by eight different operating surgeons, which may have introduced intersurgeon variability.
Disclosure: This research was supported by Cipla Ltd (India). Please see the original reference for a full list of disclosures.
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