Elsevier

Ophthalmology

Volume 123, Issue 2, February 2016, Pages 302-308
Ophthalmology

Original article
Efficacy of Intracameral Moxifloxacin Endophthalmitis Prophylaxis at Aravind Eye Hospital

https://doi.org/10.1016/j.ophtha.2015.09.037Get rights and content

Purpose

To compare the rate of postoperative endophthalmitis before and after initiation of intracameral (IC) moxifloxacin for endophthalmitis prophylaxis in patients undergoing cataract surgery.

Design

Retrospective, clinical registry.

Participants

All charity and private patients (116 714 eyes) who underwent cataract surgery between February 15, 2014, and April 15, 2015, at the Madurai Aravind Eye Hospital were included. Group 1 consisted of 37 777 eyes of charity patients who did not receive IC moxifloxacin, group 2 consisted of 38 160 eyes of charity patients who received IC moxifloxacin prophylaxis, and group 3 consisted of 40 777 eyes of private patients who did not receive IC moxifloxacin.

Methods

The electronic health record data for each of the 3 groups were analyzed, and the postoperative endophthalmitis rates were statistically compared. The cost of endophthalmitis treatment (groups 1 and 2) and the cost of IC moxifloxacin prophylaxis (group 2) were calculated.

Main Outcome Measures

Postoperative endophthalmitis rate before and after initiation of IC moxifloxacin endophthalmitis treatment cost.

Results

Manual, sutureless, small incision cataract surgery (M-SICS) accounted for approximately all of the 75 937 cataract surgeries in the charity population (97%), but only a minority of the 40 777 private surgeries (21% M-SICS; 79% phacoemulsification). Thirty eyes in group 1 (0.08%) and 6 eyes in group 2 (0.02%) were diagnosed with postoperative endophthalmitis (P < 0.0001). The group 3 endophthalmitis rate was 0.07% (29 eyes), which was also higher than the second group's rate (P < 0.0001). There were no adverse events attributed to IC moxifloxacin in group 2. The total cost of treating the 30 patients with endophthalmitis in group 1 was virtually identical to the total combined cost in group 2 of routine IC moxifloxacin prophylaxis and treatment of the 6 endophthalmitis cases.

Conclusions

Routine IC moxifloxacin prophylaxis achieved a highly significant, 4-fold reduction in postoperative endophthalmitis in patients undergoing M-SICS. Compared with previous studies, having such a high volume of patients undergoing surgery during a relatively short 14-month time period strengthens the conclusion. This study provides further evidence that moxifloxacin is an effective IC prophylactic antibiotic and suggests that IC antibiotics should be considered for M-SICS and phacoemulsification.

Section snippets

Study Design

This is a retrospective, clinical registry–based study. The study protocol was conducted according to the principles described in the Declaration of Helsinki, and Institutional Review Board/Ethics Committee approval was obtained. The study population comprises all charity and private patients who underwent cataract surgery between February 15, 2014, and April 15, 2015, at the Madurai AEH. The charity population included patients who were transported to the base hospital for surgery from

Results

A total of 116 714 cataract procedures (including 12 601 bilateral cases) were performed from the February 15, 2014, to April 15, 2015, study period at the Madurai AEH. Of the 75 937 cataract surgeries performed in the charity population during this 14-month period, 37 777 (49.7%) did not receive IC moxifloxacin (group 1) and 38 160 (50.3%) did (group 2). There were 5364 and 4616 bilateral cases in groups 1 and 2, respectively.

Overall, 96.9% of the charity patients underwent M-SICS, and the

Discussion

Although phacoemulsification is the procedure of choice in developed countries, M-SICS is widely used in many developing world settings, where there is typically a large backlog of cataract blindness because of the lack of health care resources and ophthalmologists.17, 18 Compared with phacoemulsification, we and other groups have found M-SICS to be faster, more efficient, and more cost effective.22, 23, 24 Our large study at the Madurai AEH previously demonstrated that M-SICS is also safer

References (35)

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    One recent in vitro study of 111 isolates of coagulase-negative Staphylococcus from clinical endophthalmitis specimens found that more than one third were resistant to ciprofloxacin and moxifloxacin.30 It has been posited that the high concentration of moxifloxacin in an intracameral injection improves its efficacy and minimizes this risk.4 We are not able to ascertain accurately whether intracameral moxifloxacin resulted in endophthalmitis organisms that were more resistant to treatment or susceptible to fewer antibiotics.

  • Chinese guideline for cataract surgery in adults (2023)

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See Editorial on page 226.

Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Author Contributions:

Conception and design: Haripriya, Chang, Ravindran

Data collection: Namburar, Smita

Analysis and interpretation: Haripriya, Namburar, Smita, Ravindran

Obtained funding: Not applicable

Overall responsibility: Haripriya, Chang

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