Efficacy of Intracameral Moxifloxacin in Prevention of Post-cataract Surgery Endophthalmitis: A Randomized Control Trial.

Abstract

Purpose: To study the efficacy of intracameral moxifloxacin 0.5% in prevention of post-cataract surgery endophthalmitis.

Settings: Three tertiary eye centres of northern India.

Design: Multicentric randomized clinical study.

Methods: Sixty thousand eyes undergoing phacoemulsification with intraocular lens (IOL) implantation were randomized in two groups in 1:1 format from January 2018 to June 2024. Group 1 received intracameral moxifloxacin (cases) while group 2 did not receive intracameral antibiotics (control). Any case of endophthalmitis in the post-operative period up to six weeks in both groups was documented and managed according to routine protocols.

Results: The endothelial cell counts were comparable pre-operatively (p=0.18) and post-operatively (p=0.54). Six eyes (0.02%) in intracameral moxifloxacin group developed endophthalmitis as compared to sixteen eyes in control group (0.05%) (p=0.04). The odds of developing endophthalmitis were 2.5 times lower with the usage of intracameral moxifloxacin. The mean time of presentation of endophthalmitis in group 1 and 2 were 32.26 ± 23.42 and 23.52 ± 13.91days respectively. Eight cases (8/22; 36.36%) were culture positive, of which one was fungus (n=1/8; 12.5%) while rest were bacteria (n=7/8; 87.5%). Coagulase negative Staphylococcus (CoNS) was the most common isolated micro-organism (n=4; 50%). Resistance to fluoroquinolones were higher for ciprofloxacin (5/7) and gatifloxacin (3/7) than moxifloxacin (2/7). At three months, 17/22 eyes (77.27%) responded to treatment and endophthalmitis resolved by three months. However, one eye in group 1 and three eyes in group 2 developed phthisis (4/22; 18.18%).

Conclusion: Intracameral moxifloxacin is safe and effective in preventing post-cataract surgery acute bacterial endophthalmitis.