Endophthalmitis reduction with intracameral moxifloxacin in
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It is widely acknowledged that posterior capsule rupture (PCR) is a risk factor for postoperative endophthalmitis (POE). The use of antibiotic prophylaxis to prevent POE in eyes that have experienced PCR has not been specifically studied. Mounting evidence suggests that intracameral (IC) antibiotic prophylaxis reduces the rate of POE with cataract surgery. This study was aimed To analyze the posterior capsule rupture (PCR) rates among staff and trainee cataract surgeons, and the postoperative endophthalmitis (POE) rates in uncomplicated and complicated eyes both with and without intracameral moxifloxacin prophylaxis (ICMP).

POE rates with and without ICMP were statistically compared for all eyes and separately for trainees versus staff, for phacoemulsification versus manual small-incision cataract surgery (M-SICS), and for a subgroup of eyes complicated by PCR or requiring secondary surgery.

All cataract surgeries (2 062 643) performed during the 8-year period from 2011 to 2018 at the 10 regional Aravind Eye hospitals were included in the analysis. With ICMP, the overall POE rate declined from 692 of 993 009 eyes to 185 of 1 069 634 eyes. This was independently significant for phacoemulsification and for M-SICS. The overall PCR rate was 28 352 of 2 062 643 eyes, and it was statistically higher for trainees irrespective of the surgical method. Both staff and trainee surgeons had higher PCR rates with phacoemulsification than with M-SICS. Absent ICMP, PCR increased the overall POE rate by more than 7-fold to 63 of 14 505 eyes. ICMP reduced the POE rate after PCR to 25 of 13 847 eyes. This ICMP benefit was separately significant for both M-SICS and phacoemulsification. The POE rate was especially high after secondary IOL implantation.

Clinical surveys have shown that many surgeons do not routinely employ IC antibiotic prophylaxis. However, because PCR so significantly increases the POE rate, and based on the results from this large retrospective series, the study recommends that IC antibiotic prophylaxis is strongly considered for eyes complicated by PCR or undergoing secondary IOL implantation after previous PCR. Conclusively, ICMP reduced the POE rate overall, with phacoemulsification, with M-SICS, and in eyes with PCR.

Status: https://journals.lww.com/jcrs/FullText/2019/09000/Endophthalmitis_reduction_with_intracameral.4.aspx
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