EFFICACY OF INTRACAMERAL MOXIFLOXACIN VERSUS TOPICAL MOXIFLOXACIN IN PREVENTING ACUTE ENDOPHTHALMITIS AFTER CATARACT SURGERY BY PHACOEMULSIFICATION

Authors

  • Faisal Anwar Sharif Medical & Dental College, Sharif City Hospital, Lahore-Pakistan
  • Nazia Qamar Sharif Medical & Dental College Sharif City Hospital, Lahore-Pakistan
  • Asif Bashir Sharif Medical & Dental College Sharif City Hospital, Lahore-Pakistan
  • Muhammad Tahir Ghaffar Al Aleem Medical College, Lahore-Pakistan
  • Mohammad Hasan Bokhari Mayo Hospital, Lahore-Pakistan

DOI:

https://doi.org/10.55519/JAMC-02-12663

Keywords:

Intracameral moxifloxacin , antibiotic prophylaxis , cataract surgery , phacoemulsification , Endophthalmitis

Abstract

Background: Endophthalmitis is an acute infection of anterior and posterior segment of the eye involving aqueous humour and vitreous cavity along with the other structures. It is classified into many types including bacterial, Fungal, protozoal, viral and atypical forms. Most common route of infection is exogenous either after the surgery or traumatic perforation Objectives were of evaluate the efficacy of intracameral moxifloxacin versus topical moxifloxacin in preventing postoperative acute endophthalmitis after cataract surgery by phacoemulsification. Methods: Patients undergoing cataract surgery by phacoemulsification are divided into two groups. Group A and group B. Cataract surgery was performed by phacoemulsification in both the groups by the same consultant. Group A was given 0.5% intracameral moxifloxacin 0.1ml undiluted at the end of surgery and Group B received topical moxifloxacin eyedrops and no intracameral medicine at the end of surgery. Post-operative medicine in both the groups was same for 1st twenty-four hours that is topical dexamethasone 0.1%. Postoperative assessment was made on the next day or after twenty-four hours of surgery Our primary outcome was incidence of postoperative acute endophthalmitis. Results: The study comprised 150 eyes of patients. There were 75 patients in Group A (intracameral moxifloxacin) and 75 patients in Group B (Topical group). Mean age of the patients was 58 years . No case of endophthalmitis was reported in group A (intracameral moxifloxacin). Three cases in group A had acute toxic anterior segment with moderate corneal oedema and severe anterior chamber reaction which resolved in a week time without intravitreal medication. Group B (Topical Moxifloxacin) did not report any case of endophthalmitis. The difference between the two groups was very mild anterior chamber reaction in intracameral group as compared to topical group. Conclusion: 0.1 ml undiluted intracameral moxifloxacin 0.5% can be given as a last step in cataract surgery by phacoemulsification to prevent postoperative acute endophthalmitis infection. This drug administration is not totally safe as our three cases developed drug reaction with moderate corneal oedema and anterior chamber reaction that resolved in a week time.

References

Rangel CM, Parra MM, Corrales MI, Garcia D, Sánchez-Ávila R, Varón CL, et al. Endophthalmitis in ophthalmological referral centre in Colombia: aetiology and microbial resistance. Cesk Slov Oftalmol 2022;78(4):160–73.

Endophthalmitis Study Group, European Society of Cataract & Refractive Surgeons. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg 2007;33(6):978–88.

Melega MV, Alves M, Cavalcanti Lira RP, Cardoso da Silva I, Ferreira BG, Assis Filho HL, et al. Safety and efficacy of intracameral moxifloxacin for prevention of post-cataract endophthalmitis: randomized controlled clinical trial. J Cataract Refract Surg 2019;45(3):343–50.

Garg P, Roy A, Sharma S. Endophthalmitis after cataract surgery: epidemiology, risk factors, and evidence on protection. Curr Opin Ophthalmol 2017;28(1):67–72.

Althiabi S, Aljbreen AJ, Alshutily A, Althwiny FA. Postoperative endophthalmitis after cataract surgery: an update. Cureus 2022;14(2):e22003.

Scantling-Birch Y, Naveed H, Khan H, Sheikh I, Zia R. A national survey of endophthalmitis prophylaxis during cataract surgery in pakistan: a 2020 perspective. Pak J Ophthalmol 2022;38(1):21–30.

Sharma T, Kamath MM, Kamath MG, Nayak RR, Bairy KL, Musmade PB. Aqueous penetration of orally and topically administered moxifloxacin. Br J Ophthalmol 2015;99(9):1182–5.

Nguyen ET, Shorstein NH. Preparation of intracameral antibiotics for injection. J Cataract Refract Surg 2013;39(11):1778–9.

Barry P. Adoption of intracameral antibiotic prophylaxis of endophthalmitis following cataract surgery: update on the ESCRS Endophthalmitis Study. J Cataract Refract Surg 2014;40(1):138–42.

Gore DM, Angunawela RI, Little BC. United Kingdom survey of antibiotic prophylaxis practice after publication of the ESCRS Endophthalmitis Study. J Cataract Refract Surg 2009;35(4):770–3.

Endophthalmitis Study Group, European Society of Cataract & Refractive Surgeons. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg 2007;33(6):978–88.

Feys J, Emond JP, Salvanet-Bouccara A, Dublanchet A. [Bacterial contamination: epidemiology in cataract surgery]. J Fr Ophtalmol 2003;26(3):255–8.

Espiritu CRG, Caparas VL, Bolinao JG. Safety of prophylactic intracameral moxifloxacin 0.5% ophthalmic solution in cataract surgery patients. J Cataract Refract Surg 2007;33(1):63–8.

McGee DH, Holt WF, Kastner PR, Rice RL. Safety of moxifloxacin as shown in animal and in vitro studies. Surv Ophthalmol 2005;50(Suppl 1):S46–54.

Mather R, Karenchak LM, Romanowski EG, Kowalski RP. Fourth generation fluoroquinolones: new weapons in the arsenal of ophthalmic antibiotics. Am J Ophthalmol 2002;133(4):463–6.

Published

2024-06-02

Most read articles by the same author(s)