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Intracameral antibiotic lowers endophthalmitis rate in high-risk cases

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WAIKOLOA, Hawaii — Prophylactic use of intracameral antibiotics during cataract surgery can reduce endophthalmitis in high-risk cases, according to a speaker here at Hawaiian Eye 2019.

David F. Chang, MD, discussed the results of a study that compared patients who were given intracameral moxifloxacin vs. those who did not receive intracameral antibiotics at 10 hospitals within the same health system between 2012 and 2017.

The study included more than 1.5 million cases and showed that, overall, the rate of endophthalmitis went down from seven cases per 10,000 to two cases per 10,000, Chang said.

“What’s nice with such a large database, you can look individually at phaco and you can look at the manual incision and see that this holds, but you can also look at things that are not common like posterior capsule rupture,” Chang said.

There were approximately 22,000 cases of posterior capture rupture recorded, of which half received intracameral antibiotics.

Those who did not receive moxifloxacin had an endophthalmitis rate of 44 per 10,000 cases, while those who did receive it had an endophthalmitis rate of 19 per 10,000 cases, which Chang described as “highly statistically significant.”

In addition, reoperation procedures such as secondary IOL had a higher rate of endophthalmitis, which was brought down dramatically with the addition of moxifloxacin.
“What happens with moxifloxacin is that all of these rates go down,” Chang said. “If you are not routinely using it, the times that you probably should is if you experience posterior capsule rupture or you do a secondary procedure with an open capsule where clearly the risk is way higher.” – by Rebecca L. Forand

Reference:

Chang D. Pharmacologic management following vitreous loss. Presented at: Hawaiian Eye; Jan. 19-25, 2019; Waikoloa, Hawaii.

Disclosure: Chang reports no relevant financial disclosures.