Impact on corneal morphology after cataract surgery with intracameral moxifloxacin in neglected hard cataracts

Abstract

Aim To evaluate corneal morphology after use of 0.5% intracameral moxifloxacin (ICM) in cataract surgery in patients who presented late with hard cataracts. Methods Cross-sectional study conducted from June-2021 to December-2021 at a tertiary eye-care center. 90 patients over 60 years with high-risk characteristics for Covid-19, who presented late with higher grades of nuclear-sclerosis (NS), were included. They underwent phacoemulsification and 0.5%moxifloxacin (0.1 ml) was injected intracamerally at the end of surgery. Best-corrected visual acuity (BCVA), intraocular pressures (IOP), endothelial cell density (ECD), coefficient of variation in cell-area (CoV), hexagonality (Hex) and central corneal thickness (CCT) were measured preoperatively and postoperatively on day1, day7 and day30. Statistical analysis was done by Anova test. p-value<0.05 was considered significant. Results Mean age of presentation was 65.26±8.3 years. Mean preoperative BCVA (1/60-to-6/60), IOP (16.7±2.3 mm of Hg), CCT (523.93±39.6µ), ECD (2547±302.08cells/mm2), Hex (47.04±5.7%) and CoV (37.57±3.9) changed to BCVA (6/9-to-6/6), IOP (17.5±2.1 mm of Hg), CCT (538.42±36.9µ), ECD (2388.40±339.25cells/mm2), Hex (44.44±5.6%) and CoV (39.09±4.5) at day30 postoperative. Average rate of change at day30 was increase in CCT (2.89%), ECD loss (6.4%), decrease in Hex (4.9%) and increase in CoV (4.6%), though clinically insignificant. No case of endophthalmitis or toxic-anterior segment syndrome seen. Conclusion 0.5% moxifloxacin (0.1 ml) is safe as intracameral antibiotic to prevent postoperative infection in high-risk patients. The reported changes in the corneal parameters were within the range of any routine surgeries of hard senile cataracts. No specific effect could be attributed to ICM.

Intracameral antibiotics during cataract surgery: efficacy, safety, and cost–benefit considerations

“…One study showed that preservative-free intracameral 0.5% moxifloxacin/0.1% dexamethasone ophthalmic solution, Vigadexa (Alcon, Inc.), did not lead to increased endothelial cell loss and no patient showed signs of TASS [67 ▪ ]. Other studies, including a prospective randomized trial, showed no increased safety risk, changes in macular thickness, choroidal thickness, or endothelial cell count [34,35,52,68,69,70 ▪ ]. Based on available evidence, we believe moxifloxacin is well tolerated for clinical use at approximately 0.5 mg per 0.1 ml.…”

Corneal parameters in diabetics versus non-diabetics and correlation with various blood sugar parameters

“…However, limited studies have reported a thicker cornea in diabetics [ 24 - 27 ]. This difference in agreement needs to be reinforced in the presence of biochemical factors, including glycemic controls, which may cause variations in swelling pressure and increased corneal thickness [ 28 ]. It is further pertinent to enforce that different studies have assessed various corneal parameters using different contact and non-contact equipment, which use automatic, semi-automatic, or manual methods.…”