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Intravitreal steroid-antibiotic a possible alternative to drops after cataract surgery

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BOSTON — Despite diminished visual acuity immediately after surgery, intravitreal placement of combined triamcinolone acetonide and moxifloxacin proved effective in preventing inflammation and cystoid macular edema after cataract surgery, according to a study.

Intravitreal delivery of the drug may be a viable alternative to eye drops, M. Stewart Galloway, MD, said at the American Society of Cataract and Refractive Surgery annual meeting.

M. Stewart Galloway

“We know that patient drop compliance is less than optimal. Triamcinolone has proven to be effective in the treatment of CME and is present in the vitreous at detectable levels for at least 8 months after injection,” Galloway said.

He presented results of a retrospective review of 1,575 eyes that underwent phacoemulsification and IOL implantation and received intravitreal TriMoxi (Imprimis Pharmaceuticals) instead of a topical antibiotic and steroid postoperatively.

TriMoxi is compounded, preservative-free triamcinolone acetonide and moxifloxacin injected “transzonularly” into the anterior vitreous. Total drug delivery is 3 mg triamcinolone acetonide and 0.2 mg moxifloxacin.

Patients were evaluated 4 to 7 hours, 3 to 4 weeks and 6 months postoperatively.

Uncorrected visual acuity was 20/100 or worse in 51% of patients immediately after surgery. However, UCVA was 20/40 or better in 78% of eyes and 20/25 or better in 37% of eyes at 1 month.

Best corrected visual acuity was 20/40 or better in 96% of eyes and 20/25 or better in 79% of eyes at 1 month.
Mean IOP was 21.8 mm Hg at 4 to 7 hours after surgery and 14.5 mm Hg at 3 weeks.

The overall incidence of CME was 2%; eliminating patients with risk factors associated with diabetes or epiretinal membrane, the incidence was 1.5%. The incidence of CME was 3.5% for patients with risk factors.

No cases of endophthalmitis were reported.

Disclosure: Galloway has no relevant financial disclosures.