Administration of intracameral moxifloxacin prophylaxis prior to glaucoma surgery can help prevent acute postoperative endophthalmitis, according to research published in Ophthalmology Glaucoma.
The investigators of this retrospective study assessed the effectiveness of intracameral moxifloxacin prophylaxis in reducing acute postoperative endophthalmitis in patients who underwent either trabeculectomy alone or trabeculectomy combined with cataract extraction.
The study included 57,986 eyes that had undergone glaucoma surgery at Aravind Eye Hospital between 2009 and 2018. The investigators analyzed the participants’ electronic health records and compared rates of acute postoperative endophthalmitis both before and after implementation of routine intracameral moxifloxacin. Participants were divided into two groups based on the dates of implementation: Group 1, consisting of patients who did not receive intracameral moxifloxacin (n=38,900 eyes), and Group 2, consisting of patients who did receive intracameral moxifloxacin prophylaxis (n=19,086 eyes). Researchers noted that the primary study outcome was the difference in group rates of postoperative endophthalmitis recorded during the six-week postoperative period. The investigators adjusted their analyses for differences in baseline demographics, as well as for confounding ocular and surgical variables.
The overall difference in noninfectious postoperative complication rates between groups was not significant (0.81% vs 0.67%; P =.07). However, the rate of early postoperative endophthalmitis was significantly lower in Group 2 vs Group 1 (0.03% vs 0.08%; P =.03). Participants who received intracameral moxifloxacin were approximately 2.5 times less likely to experience infection (odds ratio [OR] 0.39; 95% CI, 0.16-0.95; P =.039), and nearly four times less likely to experience infection when adjusting for age and gender (OR 0.26; 95% CI, 0.09-0.74; P =.012). When stratified by procedure type, the rate of acute postoperative infection following introduction of intracameral moxifloxacin was lower for participants both undergoing trabeculectomy alone (0.09% to 0.03%; P =.27) and combined trabeculectomy/cataract extraction (0.08% to 0.03%; P =.06).
Limitations of the study included its retrospective nature and that the electronic database did not contain consistent records on use of mitomycin C and other antimetabolites, nor did reports on differences in surgical approach or technique over the 10-year span. However, all surgeons were senior glaucoma fellows or specialists practicing at a single institution.
The investigators suggested that the introduction of intracameral moxifloxacin prophylaxis was effective to reduce early postoperative infection in patients undergoing glaucoma surgery, in which intracameral moxifloxacin was associated with a four-fold lower rate of acute endophthalmitis following both trabeculectomy and combined cataract/trabeculectomy surgery.
Mitchell W, Tom L, Durai I, et al. The effectiveness of intracameral moxifloxacin endophthalmitis prophylaxis for trabeculectomy [published online July 29, 2020]. Ophthalmol Glaucoma. doi: 10.1016/j.olga.2020.07.008.