Abstract
To evaluate the safety and efficacy of 0.05 mL intracameral injection of moxifloxacin in patients who underwent phacoemulsification and intraocular lens (IOL) implant. Retrospective study comprising patients who underwent phacoemulsification and IOL implant between January 2009 and December 2013. Patients were divided into two groups. Group A followed standard endophthalmitis prevention protocol and group B followed the same protocol plus intracameral injection of 0.05 mL of moxifloxacin hydrochloride at 5.45 mg/mL, immediately after IOL implant. Medical records from 7,195 eyes of 3,751 patients (median age: 67.8 ± 8.96, range: 48-83 years, 53.8% female) were evaluated. Group A included 3,515 eyes of 1,838 patients and group B included 3,680 eyes of 1,913 patients. The incidence of endophthalmitis in group A was 0.22% (8:3,515 eyes) and in group B was 0.03% (1:3,680 eyes, p=0.0198, Fischer's exact test). No toxicity or inflammation related to the use of moxifloxacin was observed. There was a 7.3-fold lower ratio of endophthalmitis in the group that received moxifloxacin intracameral injection. This study provides further evidence that moxifloxacin is an effective intracameral prophylactic antibiotic.
Highlights
Rare, postoperative endophthalmitis is one of the most feared complications of cataract surgery
Despite the significant reduction in recent years, considering the millions of people who undergo cataract surgery each year, postoperative endophthalmitis still poses a significant public health issue, which has been addressed in several studies[5,6]
Patients were divided into two groups: group A received one drop of 5% povidone-iodine (Ophthalmos, São Paulo, Brazil) 15 minutes before surgery and postoperative antibiotics eye drops 4 times per day for 10 days; group B received the same prophylaxis for endophthalmitis as group A, plus an in tracameral (IC) injection of 0.05 mL of commercially available moxifloxacin hydrochloride at 5.45 mg/mL (Vigamox®, Alcon Laboratories, Inc., Fort Worth, TX) immediately after intraocular lens (IOL) implant
Summary
Postoperative endophthalmitis is one of the most feared complications of cataract surgery. It may significantly compromise visual function and even the anatomical integrity of the eye. At the beginning of the twentieth century, before the development of antibiotics, the incidence of postoperative ocular infection was approximately 1%-5%(1); nowadays, the percentage of endophthalmitis after intraocular surgery has been lowered to 0.04% to 0.2%(2-4). Despite the significant reduction in recent years, considering the millions of people who undergo cataract surgery each year, postoperative endophthalmitis still poses a significant public health issue, which has been addressed in several studies[5,6]. The preoperative use of povidone-iodine is an effective method to prevent endophthalmitis[5]. Administration of systemic or periocular injections of antibiotics is controversial and there is insufficient evidence to support its use[6]
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