Dose and administration of intracameral moxifloxacin for prophylaxis of postoperative endophthalmitis

Abstract

To review current and past practices of intracameral antibiotic administration for infection prophylaxis in cataract surgery; to review the benefits and liabilities of available prophylactic drugs, dosage determination, and administration protocols; and to devise an optimum dose and administration protocol for intracameral moxifloxacin. Humber River Hospital and the University of Toronto, Toronto, Ontario, Canada. Retrospective evaluation of treatment modality. This study consisted of a detailed review of the history, drugs, and methods of intracameral prophylaxis and microbiological and pharmacodynamics analysis of options. A review of potential drug sources and doses was performed and 1 drug, dose, and administration protocol was selected. The current method's adoption reasons are described followed by the authors' experience. A single infection in 3430 cases occurred with a moxifloxacin-resistant strain of Staphylococcus epidermidis when moxifloxacin 100 mcg in 0.1mL was used. Increasing the dose and changing the administration technique resulted in no infections in 4601 cases and no detrimental side effects or complications. Intracameral moxifloxacin prepared by dilution of 3cc moxifloxacin 0.5% (Vigamox) with 7cc balanced salt solution and with the administration of 0.3 to 0.4cc (450 to 600 mcg.) as thefinal step in cataract surgery via the side port after the main incision has been sealed and hydrated showed advantages over alternative intracameral antibiotic prophylactic methods, with minimum risk. Neither author has a financial or proprietary interest in any material or method mentioned.