Milad Modabber
Dept. of Ophthalmology, McGill University, Canada
Title: The role of Intracameral Moxifloxacin for Prophylaxis of Postoperative Endophthalmitis
Biography
Biography: Milad Modabber
Abstract
PURPOSE: Post-operative endophthalmitis (POE) is an uncommon yet potentially devastating complication of cataract surgery. The landmark study by the European Society of Cataract and Refractive Surgeons (ESCRS) clearly demonstrated the benefit of intracameral antibiotic prophylaxis in reducing the incidence of POE. However, it only tested one antibiotic at one concentration. The advent of fourth-generation fluoroquinolones, including Moxifloxacin, have since shown to be the most effective broad-spectrum topical antibiotics. Here, we seek to evaluate the efficacy and liabilities of the available prophylactic intracameral antibiotics, and to devise an optimum dosing and administration protocol for intracameral moxifloxacin.
METHODS: Retrospective review of all cataract surgical cases, performed sequentially by the senior author (S.A.A.), using clear corneal incisions, with no cases excluded. The rates of POE using Intracameral vancomycin were compared with that of intracameral moxifloxacin following practice pattern transition to Moxifloxacin. The administration dosing and regimen of the intracameral antibiotics, as well as microbiological and pharmacodynamics analysis of the medications were reviewed.
RESULTS: Intracameral vancomycin was used in the first 4797 cases, with no POE cases. Following discovery of the risk of Toxic anterior segment syndrome (TASS) with Canada’s generic Vancomycin, transition was made to moxifloxacin. Using intracameral moxifloxacin (100 mcg in 0.1 mL), a single case of POE in 3430 cases occurred with a moxifloxacin-resistant strain of Staphylococcus epidermidis. Increasing the dose and revising the administration technique of intracameral moxifloxacin (450 to 600 mcg) resulted in no cases of POE in 4601 subsequent cases. No adverse side effects or complications were observed.
CONCLUSIONS: Intracameral moxifloxacin injection into the anterior chamber as the final step in cataract surgery is safe and effective. Based on its favorable potency, penetration, and safety profiles, moxifloxacin may provide a superior alternative for intracameral antibiotic in postoperative endophthalmitis prophylaxis.