Endophthalmitis prophylaxis study. Report 1: Intracameral cefuroxime and moxifloxacin prophylaxis for the prevention of postcataract endophthalmitis in rural India

Abstract

Purpose: Intracameral antibiotics are known to reduce the incidence of acute endophthalmitis. Various drugs are available for intracameral use. This prospective study was carried out to compare the efficacies of intracameral cefuroxime and moxifloxacin prophylaxis in reducing the incidence of acute endophthalmitis after cataract surgery in rural India. Methods: This was a prospective, nonrandomized, comparative, interventional study. Between October 2016 and March 2018, 15 eye care facilities spread over four Indian states were preselected to use either of the intracameral antibiotics, cefuroxime or moxifloxacin, following cataract surgery (phacoemulsification or manual small incision cataract surgery, SICS). The main outcome measure was the occurrence of acute clinical endophthalmitis within six weeks of the surgery. This was compared with the earlier rate of endophthalmitis in the same locations. Results: The study was done in 42,466 eyes. Of the total, 42.2% received intracameral cefuroxime and 57.8% received intracameral moxifloxacin. SICS was performed more often. Clinical acute endophthalmitis occurred in 15 eyes. This accounted to a 72.22% reduction, from the earlier 0.126% to 0.035%, of postcataract surgery acute endophthalmitis. The reduction in the incidence of endophthalmitis after intracameral cefuroxime was 0.017% and that after intracameral moxifloxacin was 0.049%. With either intracameral antibiotics, the reduction in incidence was statistically significant ( P < 0.001), but not between the molecules. Intracameral cefuroxime showed 66.67% reduction and intracameral moxifloxacin showed 74.74% reduction. Conclusion: A 3.6-fold decrease in postcataract surgery endophthalmitis was observed upon the use of intracameral antibiotics in rural India. Both intracameral cefuroxime and moxifloxacin proved efficacious.

Endophthalmitis Prophylaxis Study, Report 2: Intracameral antibiotic prophylaxis with or without postoperative topical antibiotic in cataract surgery

“…All patients received intracameral antibiotic, preselected for ICC or ICM (described in EPS # 1). [ 16 ] Following surgery, all patients received topical corticosteroid (1% prednisolone acetate), and the decision to prescribe topical antibiotic was left to the discretion of the operating surgeons. In general, the operating surgeon did not prescribe postoperative topical antibiotic to people with good ocular hygiene (preoperatively absence of grade 3 meibomitis and/or blepharitis) and in eyes that had no intra-operative complications.…”

“…The study population and methodology is already described. [ 16 ] In brief, the study included patients who underwent cataract surgery between October 2016 and March 2018 in 15 rural eye centres network in India. The centres, selected based on the distance from the eye institute tertiary centres (up to 350 km and/or 2-8 hours of journey), were divided into two groups- one group to use ICC and the other to use ICM.…”

“…The Endophthalmitis Prophylaxis Study (EPS) was designed to prospectively compare the efficacy of intracameral cefuroxime (ICC) and intracameral moxifloxacin (ICM) in reducing the incidence of acute endophthalmitis after cataract surgery (primary aim; EPS#1). [ 16 ] Intracameral cefuroxime and moxifloxacin, with proven safety and efficacy, were used in the study. [ 4 13 16 ] The secondary aim of the EPS was to look at the incidence of endophthalmitis with and without topical antibiotics after intracameral antibiotic.…”

“…[ 16 ] Intracameral cefuroxime and moxifloxacin, with proven safety and efficacy, were used in the study. [ 4 13 16 ] The secondary aim of the EPS was to look at the incidence of endophthalmitis with and without topical antibiotics after intracameral antibiotic. The current study (EPS#2) analyzed the eyes that received intracameral antibiotic but did not receive postoperative topical antibiotic.…”

Commentary: Role of antibiotics in cataract surgery

“…The present study highlighted the efficacy of intracameral moxifloxacin and cefuroxime in reducing rates of endophthalmitis in rural settings. [ 9 ] Interestingly, the decision to administer postoperative antibiotics was left to the discretion of treating surgeon. Moxifloxacin, being a 4 th generation fluoroquinolone offers distinct advantages of gram-negative bacterial coverage and dose-dependent activity.…”