Macular and choroidal thickness after intracameral moxifloxacin for prevention of postcataract endophthalmitis

Abstract

Purpose: To determine any changes in macular or choroidal thickness associated with the use of intracameral moxifloxacin as postcataract endophthalmitis prophylaxis. Setting: University of Campinas, Campinas, São Paulo, Brazil. Design: Prospective, randomized, partially masked, single-site clinical trial. Methods: Phacoemulsification surgery patients in the experimental group (Group A) received a 0.03 mL intracameral injection of undiluted moxifloxacin from a sealed bottle immediately after phacoemulsification surgery (150 μg in 0.03 mL—Vigamox solution), whereas the control group (Group B) did not. Investigators evaluated in masked fashion macular and choroidal thickness using spectral-domain optical coherence tomography preoperatively and postoperatively. Results: A total of 93 patients were included (48 in Group A and 45 in Group B). Baseline parameters were similar between the groups. Either of the 2 parameters assessed differed statistically between the groups or preoperatively vs postoperatively. On postoperative day 30, central macular thickness was 8.85 ± 14.78 μm in Group A and 10.26 ± 22.44 μm in Group B (P = .7232); choroidal thickness as measured by enhanced depth imaging (EDI) was 1.45 ± 16.13 μm in Group A and 3.74 ± 16.15 in Group B (P = .5017). On postoperative day 60, central macular thickness was 19.53 ± 39.28 μm in Group A and 17.14 ± 53.68 μm in Group B (P = .8363); EDI was 5.08 ± 21.96 μm in Group A and 5.24 ± 15.8 in Group B (P = .9752). Conclusions: The application of intracameral injection of 0.03 mL of undiluted 0.5% moxifloxacin during phacoemulsification surgery as endophthalmitis prophylaxis induced no changes in macular or choroidal thickness.

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.…”

Update on Retinal Drug Toxicities

“…More recently, Ferreira et al performed a prospective randomized trial to determine whether intracameral moxifloxacin was associated with any changes in the retina and choroid. They did not find any significant differences between the moxifloxacin and control group in the thickness of the retina and choroid [ 55 ].…”

Why do scientific advances take so long to be incorporated into clinical practice? The case of intracameral injection of antibiotics to prevent acute endophthalmitis after cataract surgery

“…In 2007, a major clinical study by the European Society of Cataract and Refractive Surgeons (ESCRS) (3) demonstrated the benefits of intracameral cefuroxime. Recently, three Brazilian studies have demonstrated the safety and efficacy of intracameral moxifloxacin (4)(5)(6) . Nevertheless, the adoption of such scientifically-proven strategies in clinical practice is hindered by other factors.…”