Injection Of Moxifloxacin Research Articles

A SUCCESSFUL TREATMENT OF INTRAVITREAL MOXIFLOXACIN INJECTION IN ACUTE POST-CATARACT SURGERY ENDOPHTHALMITIS: A CASE REPORT

Introduction : Endophthalmitis is a severe form of ocular inflammation and one of the most dreaded cataract surgery complications which may lead to loss of vision. Post-cataract surgery endophthalmitis is a serious complication that occurs when infecting organisms invade the posterior segment of the eye during the time of surgery. Currently, intravitreal injection of vancomycin along with ceftazidime is the first-line treatment, but another study showed a good result of intravitreal moxifloxacin injection in patients with Postoperative endophthalmitis.
 Case Illustration : We reported a 59-year-old woman presented with blurred vision, redness, and pain in the left eye 4 days after phacoemulsification. Visual acuity of LE was hand movement and anterior segment examination found that there was a conjunctival and pericorneal injection, corneal edema, cells, and anterior chamber fibrin formation. Ultrasonography examination showed severe levels of debris in the vitreous humor. Patient was diagnosed with acute post-cataract surgery endophthalmitis and received an intravitreal moxifloxacin injection. Fortunately, one week after that injection, there wasa good result in the patient’s eye condition. Visual acuity of LE improved to 0,1 and the patient planned to receive the second moxifloxacin injection to get the best possible results.
 Discussion : Moxifloxacin expresses broad-spectrum microbial coverage with a very good diffusion and low adverse effects. Moxifloxacin also has a better penetration ability into inflamed ocular tissue than all other antibiotics. Based on that, other studies said that intravitreal moxifloxacin can replace vancomycin and ceftazidime combinations for the treatment of ocular infections.
 Conclusion : Intravitreal moxifloxacin injections have a good result in acute post-cataract surgery endophthalmitis.

Comment on: Relative efficacy of intracameral moxifloxacin injection methods.

Comment on: Relative efficacy of intracameral moxifloxacin injection methods.

ASCRS clinical advisory on intracameral moxifloxacin injection for infection prophylaxis.

Moxifloxacin solution is frequently injected at the conclusion of cataract surgery for endophthalmitis prophylaxis. 2 different concentrations are most commonly available in the United States for intracameral (IC) use: 0.5% (5 mg/mL) and 0.1% (1 mg/mL). The recommended volume to be injected is different for the 2 concentrations, and incorrect dosing can increase the risk of toxic anterior segment syndrome or endophthalmitis. In addition, the U.S. Food and Drug Administration recently published an alert regarding potential adverse events associated with intraocular compounded moxifloxacin. This clinical advisory reviews the optimal dosing of IC moxifloxacin based on current evidence.

Safety of intracameral application of moxifloxacin and dexamethasone (Vigadexa®) after phacoemulsification surgery

BackgroundIntracameral antibiotics, such as moxifloxacin and cefuroxime, are safe to corneal endothelial cells and effective prophylaxis of endophthalmitis after cataract surgery. Corneal endothelial cells decrease in density after cataract surgery. Any substance used in the anterior chamber may affect corneal endothelial cells and lead to a greater decrease in density. This study wants to determine the percentage of endothelial cell loss after cataract extraction by phacoemulsification with off-label intracameral injection of moxifloxacin and dexamethasone (Vigadexa®).MethodsAn observational retrospective study was performed. The clinical records of patients undergoing cataract surgery by phacoemulsification plus intracameral injection of Vigadexa® were analyzed. Endothelial cell loss (ECL) was calculated using preoperative and postoperative endothelial cell density. The relation of endothelial cell loss with cataract grade using LOCS III classification, total surgery time, total ultrasound time, total longitudinal power time, total torsional amplitude time, total aspiration time, estimated fluid usage, and cumulative dissipated energy (CDE) was studied using univariate linear regression analysis and logistic regression analysis.ResultsThe median loss of corneal endothelial cells was 4.6%, interquartile range 0 to 10.4%. Nuclear color and CDE were associated with increased ECL. ECL>10% was associated with age and total ultrasound time in seconds.ConclusionsThe endothelial cell loss after the intracameral use of Vigadexa® at the end of cataract surgery was similar to the reported in other studies of cataract surgery without the use of intracameral prophylaxis for postoperative endophthalmitis (POE). This study confirmed the association of CDE and nuclear opalescence grade with postoperative corneal endothelial cell loss.

The Relative Efficacy of Intracameral Moxifloxacin Injection Methods.

To determine the amount of moxifloxacin remaining in the anterior chamber, immediately after its injection using three current injection methods, assuming mixing and fluid exchange with the anterior chamber contents during injection of the drug, and to determine the most desirable injection method. The University of Toronto Department of Ophthalmology and Vision Sciences and Institute of Biomedical Engineering. Mathematical modelling using first order mixing methods to assess mixing. The Kaiser method of injecting 0.5 mL x 100µg/0.1 mL does not achieve the desired 500μg level of moxifloxacin in the anterior chamber. The "straight from the bottle" method of injecting 0.1 mL x 500µg/0.1 mL is fraught with potential error, yielding a relatively unreliable final amount in the anterior chamber. Injecting 0.5 - 0.6 mL x 150µg/0.1 mL yields a result closest to the desired goal. Based on our calculation, the most accurate of current methods to deliver 500 µg moxifloxacin intracamerally is the method of 150µg/0.1 mL x 0.5 - 0.6 mL.

INCIDENCE OF ENDOPHTHALMITIS AFTER INTRA-OPERATIVE MOXIFLOXACIN INJECTION IN THE CAPSULAR BAG, BEHIND THE INTRA OCULAR LENS, IN PHACOEMULSIFICATION. A RETROSPECTIVE STUDY

to evaluate the efficacy and safety of intracapsular moxifloxacin injection at the endof phacoemulsification as a prophylactic measure against early and late endophthalmitis.

Prophylactic antibiotics for postcataract surgery endophthalmitis: a systematic review and network meta-analysis of 6.8 million eyes

To reveal optimal antibiotic prophylactic regimen for postoperative endophthalmitis (POE), we conducted systematic review and network meta-analysis. A total of 51 eligible original articles, including two randomized controlled trials, were identified. In total, 4502 POE cases occurred in 6,809,732 eyes (0.066%). Intracameral injection of vancomycin had the best preventive effect (odds ratio [OR] 0.03, 99.6% confidence interval [CI] 0.00–0.53, corrected P-value = 0.006, P-score = 0.945) followed by intracameral injection of cefazoline (OR 0.09, 99.6% CI 0.02–0.42, corrected P-value < 0.001, P-score = 0.821), cefuroxime (OR 0.18, 99.6% CI 0.09–0.35, corrected P-value < 0.001, P-score = 0.660), and moxifloxacin (OR 0.36, 99.6% CI 0.16–0.79, corrected P-value = 0.003, P-score = 0.455). While one randomized controlled trial supported each of intracameral cefuroxime and moxifloxacin, no randomized controlled trial evaluated vancomycin and cefazoline. Sensitivity analysis focusing on the administration route revealed that only intracameral injection (OR 0.19, 99.4% CI 0.12–0.30, corrected P-value < 0.001, P-score = 0.726) significantly decreased the risk of postoperative endophthalmitis. In conclusion, intracameral injection of either vancomycin, cefazoline, cefuroxime, or moxifloxacin prevented POE.

Comment on: Purifying air over the operating field with a new mobile laminar airflow device to reduce the possibility of airborne contamination.

We were interested to read the recent article by Osher et al.1 We had also previously reviewed the poster by Osher and Figueiredo, “A New Technology for Purifying the Surgical Field”, at the 2019 ASCRS Annual Meeting in San Diego that had a nice picture of the Operio System located adjacent to the patient and the surgical field. Point 1, we wish that photograph had been included in this article and the reason for the orientation or of the machine discussed further in the article. Prior to the San Diego meeting, we became concerned with the plethora of lint-like fibers on the surgical field at our institution, both clear and blue, particularly after visualizing one in Bela Lugosi-like horror in the anterior chamber on the first postoperative day (Figure 1). After recovery and ensuring that the patient did not develop endophthalmitis, we initiated a Quality Assurance Project that sought to identify the number, risk factors, and location of these fibers during a senior resident's 3-month surgical rotation (A.H.). Eighty-nine surgeries were performed between the attending and the senior resident, and 15 fibers were identified. Most fibers were seen on the approach to the eye as an instrument was inserted, but 7 were seen in the eye during nucleus manipulation, capsulorhexis, and cortex removal. Similar to the article by Osher et al., we had no episodes of toxic anterior segment syndrome, chronic uveitis, or endophthalmitis (Table 1).Figure 1 Table 1. - Fiber Location During Phacoemulsification Surgery. Cataract procedure step Cases, n Intracameral moxifloxacin injection 3 Cortex removal 3 Capsulorhexis 2 Nuclear cracking and manipulation 2 Wound closure 2 IOL injection 1 Viscoelastic removal 1 Trabecular microbypass device 1 Regarding Table 2, the denominator is 99 in the laminar flow group and 50 in the control group. We noted on initial review that the total number of fibers seen in the laminar air flow group was 13 in 99 eyes vs the control group of 16 in 50 eyes, which is only a difference of 3, which if we increased the denominator to 100 in the control group, the total number of fibers would probably double. In personal communication with the primary author, it became clear that the salient point that the article conveyed is that in the laminar air flow group, the number of fibers directly on the field was zero. In other words, all fibers in the laminar air flow group were brought onto the surgical field by an instrument that is similar to our small series, which had a very high fiber rate of 16.9%. Watson et al. in their comment on this article focus on the trend to move toward office-based surgery and they discuss a laminar downflow hood that they have been using for 1 year.2 As such, Osher et al. and Watson et al. should be complimented for addressing important factors in our surgical microenvironments including air flow, ventilation systems, the revolving door-like atmosphere in a teaching environment, and our drapes and gowns. Point 2, we would go further, like our orthopedic colleagues, to attempt to close our operating rooms to transit to protect the laminar flow, locate our automated medication dispensing systems inside our operating rooms, and recommend that we seek to eliminate or find alternatives to article and cloth-based drapes and towels. We support the efforts by Osher et al. to eliminate what we aptly defined in our Quality Assurance Project as “Fibers, Fibers, Everywhere!”

Safety of Prophylactic Intracameral Moxifloxacin Injection after Uncomplicated Phacoemulsification Surgery

Safety of Prophylactic Intracameral Moxifloxacin Injection after Uncomplicated Phacoemulsification Surgery

Non-viscoelastic Repositioning of Dislocated Toric and Non-toric Implantable Collamer Lens After Blunt Trauma

PURPOSE: To describe a new minimally invasive technique for the treatment of uncomplicated Visian Implantable Collamer Lens (ICL) (STAAR Surgical) luxation in the anterior chamber in two cases. METHODS: A single or double 1-mm watertight corneal paracentesis was made with no viscoelastic or irrigation/aspiration. The ICL was then repositioned and pupil contraction was induced with intracameral injection of acetylcholine. Hydration of the corneal paracentesis and injection of intracameral moxifloxacin 0.5% ophthalmic solution (0.5 mg/0.1 mL) were done. RESULTS: Both cases had a normal follow-up with no significant complication. First day postoperative vault evaluated with anterior segment optical coherence tomography was 480 µm for case 1 and 1,010 µm for case 2. At the last follow-up visit, the ICL was centered in both cases with a subjective vault of 2 in case 1 and a vault of 1 in case 2. No cataract formation was described. CONCLUSIONS: This minimally invasive technique can be a fast and effective method to treat ICL decentration. The corneal paracentesis should be watertight and injection of balanced salt solution in the anterior chamber should be done to increase its depth. In addition, the movement should be fast without touching the iris or the crystalline lens, only the ICL. [ Journal of Refractive Surgery Case Reports. 2022;2(1):e18–e21.]

Postoperative endophthalmitis with and without intracameral moxifloxacin prophylaxis in a high volume surgery setting

ObjectiveThis study was conducted to understand the effects of intracameral moxifloxacin in decreasing the incidence of postoperative endophthalmitis after cataract surgery in an eye hospital with a high volume surgical...

Intravitreal moxifloxacin in treatment of postcataract endophthalmitis

Postcataract endophthalmitis is a well-known and feared complication that might lead to a devastating outcome for the diseased eye. A case of postcataract extraction endophthalmitis treated with an intravitreal moxifloxacin injection prepared from commercially available preservative-free topical eyedrops (Vigamox), achieving 20/20 corrected distance visual acuity posttreatment is reported. A 70-year-old woman was found to have endophthalmitis in the left eye with hand motion vision on day 8 postcataract extraction. Accordingly, tap-and-inject procedure was performed using 0.05 mL of 0.5% moxifloxacin aspirated directly from a sealed eyedrop bottle and injected intravitreally. Forty-eight hours later, a similar second injection was given. The patient improved progressively and reached 20/20 vision 2 months later.

Intravitreal moxifloxacin injections in acute post-cataract surgery endophthalmitis: Efficacy and safety.

Purpose:The aim of this study was to evaluate the efficacy and safety of intravitreal moxifloxacin injections in the treatment of acute post-cataract surgery endophthalmitis with visual acuity equal to or greater than hand movements.Methods:Fifty two patients with post-cataract surgery endophthalmitis who presented within 6 weeks with visual acuity equal to or greater than hand movements received two intravitreal moxifloxacin injections 48 h apart. Patients with prior history of ocular disease or treatment were excluded. Patients were followed up to 3 months either for resolution of endophthalmitis or worsening of disease. Number of patients who achieved visual acuity equal to or better than 20/40 and 20/200 at the third-month follow-up visit were compared with the number of patients at presentation, using Chi-square test. In addition, pretreatment LogMAR visual acuity at the time of presentation was compared with posttreatment visual acuity at end of third month using paired t test.Results:Fifty (96.15%) patients showed complete resolution of endophthalmitis while three patients required vitrectomy. Forty-one (78.85%) and 49 (94.23%) patients achieved visual acuity equal to or better than 20/40 and 20/200, respectively, at the third-month follow-up visit as compared to eight (15.38%) and 13 (25%) patients, respectively, at presentation (P < 0.05). In addition, mean LogMAR visual acuity at the time of presentation was 0.755 which improved to 0.307 at the third-month follow-up visit (P < 0.05). None of the patients developed hypersensitivity reactions to intravitreal moxifloxacin.Conclusion:Intravitreal moxifloxacin injections showed promising results in acute post-cataract surgery endophthalmitis.

The Anterior Chamber Injection of Moxifloxacin Injection to Prevent Endophthalmitis after Cataract Surgery: A Meta-analysis.

Purpose A meta-analysis was performed to compare the efficacy of an anterior chamber injection of moxifloxacin in the prevention of endophthalmitis after cataract surgery. Methods A computer-based search of PubMed, Embase, the Cochrane Library, and the Clinical Trial database for articles related to anterior intraventricular injection of moxifloxacin for the prevention of endophthalmitis after cataract surgery was performed through April 2019. Study selection, data exclusion, and quality assessment were performed by two independent observers. Statistical analysis for the meta-analysis was performed by RevMan5.3 software. Results Eight studies were included, with a total of 123,819 eyes. The meta-analysis showed that an anterior chamber injection of moxifloxacin can prevent the incidence of endophthalmitis after cataract surgery (OR = 0.29, 95% CI (0.15, 0.56), P=0.0002), and the difference was statistically significant. There were no significant differences between the moxifloxacin injection and nonmoxifloxacin injection groups in regard to UCVA (log MAR) (SMD = −0.13, 95% CI (−0.62, 0.35), P=0.60), BCVA (log MAR) (SMD = −0.27, 95% CI (−1.28, 0.74), P=0.60), IOP (SMD = −0.04, 95% CI (−0.02, 0.01), P=0.22), corneal edema (OR = 1.03, 95% CI (0.23, 4.69), P=0.97), CCT (SMD = −0.01, 95% CI (−0.07, 0.05), P=0.77), or ECD (SMD = 0.00, 95% CI (−0.06, 0.07), P=0.94). Conclusion An anterior chamber injection of moxifloxacin can effectively prevent the incidence of endophthalmitis after cataract surgery, while the moxifloxacin injection and nonmoxifloxacin injection groups had similar results in regard to UCVA (log MAR), BCVA (log MAR), IOP, corneal edema, CCT, and ECD.

Macular and choroidal thickness after intracameral moxifloxacin for prevention of postcataract endophthalmitis.

To determine any changes in macular or choroidal thickness associated with the use of intracameral moxifloxacin as postcataract endophthalmitis prophylaxis. University of Campinas, Campinas, São Paulo, Brazil. Prospective, randomized, partially masked, single-site clinical trial. Phacoemulsification surgery patients in the experimental group (Group A) received a 0.03 mL intracameral injection of undiluted moxifloxacin from a sealed bottle immediately after phacoemulsification surgery (150 μg in 0.03 mL-Vigamox solution), whereas the control group (Group B) did not. Investigators evaluated in masked fashion macular and choroidal thickness using spectral-domain optical coherence tomography preoperatively and postoperatively. A total of 93 patients were included (48 in Group A and 45 in Group B). Baseline parameters were similar between the groups. Either of the 2 parameters assessed differed statistically between the groups or preoperatively vs postoperatively. On postoperative day 30, central macular thickness was 8.85 ± 14.78 μm in Group A and 10.26 ± 22.44 μm in Group B (P = .7232); choroidal thickness as measured by enhanced depth imaging (EDI) was 1.45 ± 16.13 μm in Group A and 3.74 ± 16.15 in Group B (P = .5017). On postoperative day 60, central macular thickness was 19.53 ± 39.28 μm in Group A and 17.14 ± 53.68 μm in Group B (P = .8363); EDI was 5.08 ± 21.96 μm in Group A and 5.24 ± 15.8 in Group B (P = .9752). The application of intracameral injection of 0.03 mL of undiluted 0.5% moxifloxacin during phacoemulsification surgery as endophthalmitis prophylaxis induced no changes in macular or choroidal thickness.

Efficacy and Side Effects of Intracameral Moxifloxacin as Prophylaxis after Cataract Surgery

Purpose: To determine the efficacy of intracameral moxifloxacin at the end of cataract surgery.&#x0D; Methods: Retrospective record based study. Study was based on a consecutive case series of patients who had cataract surgery during 2009 through 2019 in the Department of Ophthalmology at Maharishi Vashishth State Medical College, Basti (India). Intracameral preservative free moxifloxacin injection was given at the conclusion of surgery to most patients. Standardized operating room and sterilization protocols were used. All The medical records were reviewed for the 8 weeks after surgery. Post-operative endophthalmitis rate was computed using the number of cases of postoperative endophthalmitis as the numerator and the number of cataract surgeries as the denominator.&#x0D; Results: Of the 10,108 surgeries performed during study period, 2012 (19.9%) involved intracameral moxifloxacin injection. No adverse drug reactions were reported from administration of intracameral antibiotics during the study period. The post-operative endophthalmitis rate in patient who had not received intracameral antibiotic injection was 0.06%. There was no endophthalmitis case reported in patients who had received intracameral moxifloxacin injection as prophylaxis.&#x0D; Conclusion: The results of this study support the use if intracameral moxifloxacin as a routine prophylaxis for endophthalmitis after cataract surgery. Especially in rural setting as the patients postoperative instruction compliance is poor and many patients are lost to follow-ups sue to different reasons.

Chemotherapy of mycoplasmosis in sheep and goats

Mycoplasmosis in small ruminants is considered an economically important respiratory infection resulting in huge economic losses. Small ruminant mycoplasmosis is prevalent worldwide. Chemotherapeutic efficacy With Tylosin, Moxifloxacin injections and Azithromycin oral solution, in 2014 affected goats were studied. It was observed that solitary and dual combinations increased the cure rate and saved the affected goats. The percentage of cure was more in combinations than single Tylosin injection. The combination of Moxifloxacin and Azithrmycin was very effective with a 93% cure percentage. Keywords: Mycoplasma, Sheep, Tylosin, Moxifloxacin, Azithromycin.

Short-Term Non-Infectious Outcomes After a Pars Plana Intravitreal Antibiotic-Steroid Injection of Triamcinolone, Moxifloxacin, and Vancomycin During Cataract Surgery versus a Standard Postoperative Topical Regimen.

PurposeTo compare short-term non-infectious clinical outcomes after cataract surgery with an intraoperative pars plana intravitreal antibiotic-steroid (IVAS) injection of triamcinolone, moxifloxacin, and vancomycin (TMV) versus a standard postoperative topical regimen.Patients and MethodsA retrospective comparative case series of 1058 eyes (control = 487, treatment = 571) undergoing cataract surgery were included. Endpoints included best-corrected visual acuity (BCVA), intraocular pressure (IOP), and the unplanned use of anti-inflammatory topical medication in the postoperative period. The follow-up period ranged from 1 to 6 months.ResultsA final monocular BCVA of 20/25 or better was achieved in 78.8% and 87.4% of eyes in the control and treatment groups, respectively (p = 0.001). The overall incidence of an IOP spike (Δ ≥ 10 mm Hg) was not significantly different between the two groups (0.4% versus 1.9%, p = 0.027). The rates of persistent anterior chamber inflammation (PACI), rebound anterior chamber inflammation (RACI), and cystoid macular edema (CME) in the control and treatment groups were 8.0% vs 2.6% (p < 0.001), 6.4% vs 2.6% (p = 0.003), and 3.9% vs 4.7% (p = 0.511), respectively. The use of an IVAS injection of TMV conferred an increased risk of CME (odds ratio [OR] = 3.21, 95% confidence interval [CI] = 1.42 to 7.23) but no significant effect on the risk of PACI (OR = 0.34, 95% CI = 0.10 to 1.14) or RACI (OR = 0.52, 95% CI = 0.18 to 1.54) when compared to a topical regimen.ConclusionAn intraoperative IVAS injection after uncomplicated cataract surgery may be as safe and effective as a standard topical regimen in terms of postoperative IOP and anterior chamber inflammatory events, respectively. However, the efficacy of a TMV formulation for CME prophylaxis appears to be unsatisfactory. Future studies with prospective and randomized designs are needed to further evaluate this technique.

Safety and efficacy of intracameral injection of dexamethasone and moxifloxacin at the end of cataract surgery

Safety and efficacy of intracameral injection of dexamethasone and moxifloxacin at the end of cataract surgery

An Ex Vivo Evaluation of Moxifloxacin Nanostructured Lipid Carrier Enriched In Situ Gel for Transcorneal Permeation on Goat Cornea

The study was designed to fabricate the moxifloxacin nanostructured lipid carriers (MOX-NLCs) loaded in situ gel for opthalmic application to improve the corneal permeation and retention and also subside the toxic effect associated with intracameral injection of moxifloxacin in endophthalmitis treatment. Initially, Box-Behnken design was used to optimize the various factors significantly affecting the final formulation attributes. MOX-NLCs with particle size 232.1 ± 9.2 nm, polydispersity index 0.247 ± 0.031, zeta potential −16.3 ± 1.6 mV, entrapment efficiency 63.1 ± 2.4%, and spherical shape was achieved. The optimized MOX-NLCs demonstrated the Higuchi release kinetics with highest regression coefficient. Besides this, FTIR, differential scanning calorimetry, and X-ray diffraction results suggested that MOX had excellent compatibility with excipients. Furthermore, the results of ex-vivo permeation study demonstrated 2-fold higher permeation (208.7 ± 17.6 μg), retention (37.26 ± 2.83 μg), and flux (9.57 ± 0.73 μg/cm2 h) compared with free MOX in situ gel. In addition, MOX-NLCs exhibited normal corneal hydration and did not show any sign of structural damage to the corneal tissue as confirmed by histology. Therefore, the findings strongly suggest that MOX-NLCs in situ gel with higher permeation and retention can be a better alternative strategy to prevent and treat the endophthalmitis infection.