Endophthalmitis After Cataract Surgery: An Update on Recent Advances

Travis J. Peck; Samir N. Patel; Allen C. Ho


Curr Opin Ophthalmol. 2021;32(1):62-68. 

In This Article

Intracameral Moxifloxacin

The European Society for Cataract and Refractive Surgery study in 2006 remains the only randomized controlled trial analyzing the effect of intracameral antibiotic prophylaxis at the time of surgery, which found that the use of intracameral cefuroxime was associated with a five to sixfold reduction in endophthalmitis.[14] This led to an increase in the use of intracameral antibiotics among members of the American Society for Cataract and Refractive Surgery (ASCRS) at the time of cataract surgery from 14% in 2007 to 36% in 2014.[15] However, cefuroxime for intracameral use was not made widely available in the United States, and of ASCRS respondents in 2014, 52% were using vancomycin, 31% moxifloxacin, and 14% cefuroxime.[15] In 2014, a large retrospective review reported similar reductions in endophthalmitis with intracameral moxifloxacin and noted that the increased costs of moxifloxacin were offset by the savings associated with a reduction in endophthalmitis.[16]

A 0.5-mg in 0.1 ml injection of moxifloxacin allows for the median minimal inhibitory concentration of most pathogens responsible for endophthalmitis to be exceeded by 300-fold.[17] Although a significant percentage of Staphylococcal species isolated in endophthalmitis are resistant to moxifloxacin, there is a statistically significant reduction in Staphylococcus cases when moxifloxacin was administered.[16] This may be related to the high concentration achieved with intracameral injection, as the bactericidal activity of fluoroquinolones is concentration-dependent.[17] Some authors propose diluting the moxifloxacin for intracameral injection to a 0.3–0.4-ml mixture to increase the accuracy of the amount injected.[17] This technique, in combination with increasing the volume of moxifloxacin to 450–600 mcg, was shown to decrease endophthalmitis rates.[17] The safety of intracameral moxifloxacin is well established[18] and has previously been shown to be cost effective in the United States.[17]