Acute-onset postoperative endophthalmitis after cataract surgery and transzonular intravitreal triamcinolone–moxifloxacin

Kishore, Kamal; Brown, Jeffrey A.; Satar, Jennifer M.; Hahn, Joseph; Bond, William I

doi:10.1016/j.jcrs.2018.07.055

Cited by 18 publications

(17 citation statements)

References 36 publications

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“…For example, dropless cataract surgery may need reconsideration in this age group because it is unclear whether intraocular moxifloxacin levels are maintained above the MIC sufficiently long enough to fully eradicate any antibiotic-resistant staphylococci that may breach the surgical wound 59,60 ; in this regard, there have been reports of endophthalmitis after dropless cataract surgery with moxifloxacin. [61][62][63][64] Of importance, of methicillin-resistant staphylococci sourced from vitreous or aqueous humor in this study, 91% of MRSA isolates and 71% of methicillin-resistant CoNS isolates had concurrent resistance to moxifloxacin (eAppendix, eFigure 2, and eFigure 3 in the Supplement). An increasing prevalence of resistance to antibiotics, especially fluoroquinolones, with patient age has also been reported by other researchers.…”

Section: Discussionmentioning

confidence: 83%

Trends in Antibiotic Resistance Among Ocular Microorganisms in the United States From 2009 to 2018

Asbell

Sanfilippo²,

Sahm³

et al. 2020

JAMA Ophthalmol

105

131

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IMPORTANCE Antibiotic resistance in ocular infections can affect treatment outcomes. Surveillance data on evolving antibacterial susceptibility patterns inform the treatment of such infections. OBJECTIVE To assess overall antibiotic resistance profiles and trends among bacterial isolates from ocular sources collected during 10 years. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of longitudinal data from the ongoing, nationwide, prospective, laboratory-based surveillance study, the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) study, included clinically relevant isolates of Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae cultured from patients with ocular infections at US centers from January 1, 2009, to December 31, 2018.MAIN OUTCOMES AND MEASURES Minimum inhibitory concentrations were determined for various combinations of antibiotics and species. Odds ratios (ORs) were determined for concurrent antibiotic resistance; analysis of variance and χ 2 tests were used to evaluate resistance rates by patient age and geographic region; Cochran-Armitage tests identified changing antibiotic susceptibility trends over time.RESULTS A total of 6091 isolates (2189 S aureus, 1765 CoNS, 590 S pneumoniae, 767 P aeruginosa, and 780 H influenzae) from 6091 patients were submitted by 88 sites. Overall, 765 S aureus (34.9%) and 871 CoNS (49.3%) isolates were methicillin resistant and more likely to be concurrently resistant to macrolides

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Section: Discussionmentioning

confidence: 83%

Trends in Antibiotic Resistance Among Ocular Microorganisms in the United States From 2009 to 2018

Asbell

Sanfilippo²,

Sahm³

et al. 2020

JAMA Ophthalmol

105

131

View full text Add to dashboard Cite

show abstract

“…reported four cases (0.25%) of acute-onset postoperative endophthalmitis after uneventful temporal clear corneal topical dropless cataract surgery involving intravitreal triamcinolone-moxifloxacin drug combination (TriMoxi). [ 27 ] A similar study by Tyson et al . reported no incidence of endophthalmitis in a series of 1541 eyes.…”

Section: Discussionmentioning

confidence: 66%

“…Nevertheless, the dropless cataract surgery studies have demonstrated that the incidence of post cataract surgery endophthalmitis is similar to that of conventional phacoemulsification surgery where the incidence is 0.04%–0.2%. [ 27 ] This raises the question of whether these studies are good enough to prove that dropless cataract surgery is as safe as conventional phacoemulsification surgery. The answer is probably not.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of dropless cataract surgery

Bardoloi

Sarkar

Pilania

et al. 2020

Indian J Ophthalmol

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Purpose: To evaluate the clinical outcome following intraoperative transzonular intravitreal injection of triamcinolone acetonide and moxifloxacin in patients undergoing phacoemulsification cataract extraction with intraocular lens (IOL) implantation. Methods: In this prospective, non-randomized, clinical, interventional study, a total of 200 eyes were enrolled. Patients who voluntarily gave their consent after being informed about dropless cataract surgery along with its pros and cons were included. Those who had glaucoma or were known steroid responders as well as those who were lost to follow-up were excluded. 0.1 ml each of moxifloxacin (500 mg) and triamcinolone acetonide (4 mg) were injected transzonularly following IOL implantation in phacoemulsification cataract surgery with the help of 27G curved cannula. Slit-lamp examination was done to detect cells, visual acuity was noted, and intraocular pressure was measured postoperatively on day 1, 7, 30, 60, and 90. Results: Uncorrected visual acuity (UCVA) greater than 6/9 was achieved in 96% of patients at the end of 3 months. The mean IOP was found to be normal in all the cases at every visit. Twenty patients complained of floaters on postoperative day 1 (D1), which decreased to zero after 60 days (D60). None of the patients needed any eye drop during the entire postoperative period. Conclusion: The study demonstrates that this procedure is advantageous and safe.

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“…3 Unlike TA, the duration of intraocular moxifloxacin levels that exceed minimum inhibitory concentration (MIC) is relatively short after intravitreal administration and may predispose to possible infection. 7 We report a case of delayed-onset endophthalmitis following dropless cataract surgery with intravitreal Tri-Moxi. We conjecture that a fourth-generation fluoroquinolone-resistant organism (staphylococcus epidermidis) was inoculated into the eye during cataract surgery.…”

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Endophthalmitis after dropless (Tri-Moxi injection) cataract surgery

Chalam

2019

European Journal of Ophthalmology

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Introduction: A case of endophthalmitis after dropless cataract surgery with intravitreal Tri-Moxi associated with severe vision loss. Case summary: An 82-year-old male developed severe vision loss in the left eye 24 days after dropless cataract surgery with intravitreal Tri-Moxi injection. Best corrected visual acuity was hand motion in the left eye. Intraocular pressure was 13, with inferior keratic precipitates, 4 + cell with 1 mm layered hypopyon, and a plaque on the posterior capsule that blocked direct exam of the posterior segment. Ultrasonography revealed extensive vitritis without retinal or choroidal detachments. Conclusion: Endophthalmitis resolved and vision improved after management with vitreous tap, intravitreal and fortified topical antibiotics, and subsequent prompt pars plana vitrectomy. Vitreous sample grew fluoroquinolone-resistant staphylococcus epidermidis.

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Acute-onset postoperative endophthalmitis after cataract surgery and transzonular intravitreal triamcinolone–moxifloxacin

Abstract: Postoperative endophthalmitis can occur after dropless cataract surgery with intravitreal triamcinolone-moxifloxacin.

Cited by 18 publications

References 36 publications

Trends in Antibiotic Resistance Among Ocular Microorganisms in the United States From 2009 to 2018

Trends in Antibiotic Resistance Among Ocular Microorganisms in the United States From 2009 to 2018

Efficacy and safety of dropless cataract surgery

Endophthalmitis after dropless (Tri-Moxi injection) cataract surgery

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