Association for Research in Vision and Ophthalmology
Association for Research in Vision and Ophthalmology
Issue: June 2020
Source/Disclosures
Source:

Mitchell WG, et al. Effectiveness of intracameral moxifloxacin endophthalmitis prophylaxis for trabeculectomy at Aravind Eye Hospitals. Presented at: Association for Research in Vision and Ophthalmology annual meeting; June 12, 2020 (virtual meeting).

Disclosures: Mitchell reports no relevant financial disclosures.
June 15, 2020
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Intracameral antibiotic prophylaxis may lower rate of endophthalmitis after trabeculectomy

Issue: June 2020
Source/Disclosures
Source:

Mitchell WG, et al. Effectiveness of intracameral moxifloxacin endophthalmitis prophylaxis for trabeculectomy at Aravind Eye Hospitals. Presented at: Association for Research in Vision and Ophthalmology annual meeting; June 12, 2020 (virtual meeting).

Disclosures: Mitchell reports no relevant financial disclosures.
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A large study conducted at Aravind Eye Hospitals in India showed that intracameral antibiotic prophylaxis significantly reduced the risk for endophthalmitis after trabeculectomy with or without combined cataract surgery.

The study, presented at the virtual Association for Research in Vision and Ophthalmology meeting, was a retrospective cohort analysis of all trabeculectomies with or without cataract extraction carried out between 2009 and 2018 at four Aravind sites. Cataract surgery was performed by phacoemulsification in full fee-paying patients or manual small-incision cataract surgery in subsidized patients. Group 1, with 38,900 eyes operated between 2009 and 2015, underwent topical ofloxacin prophylaxis only. Group 2, with 19,086 eyes operated between 2015 and 2018, were administered intracameral moxifloxacin in addition to the topical treatment. The distribution of combined vs. single surgery was similar in the two groups.

“There was a significant 2.5 times reduced odds of infection in the patients that received [intracameral] moxifloxacin. Endophthalmitis occurred in 30 eyes in group 1 (0.08%) and six eyes in group 2 (0.03%). No difference was found in relation to combined vs. single surgery or phacoemulsification vs. incisional surgery in either group,” William G. Mitchell, MBBS, MPH, said.

Interestingly, culture results showed a difference in the organisms that caused endophthalmitis in the two groups.

“In group 1, we had staphylococcus and gram-negative species, while in group 2, we had streptococcus and gram-positive cocci, traditionally known to be less virulent species,” he said.

Intracameral prophylaxis is not the current standard of care with cataract surgery, although Sweden, where it is routinely used, has the lowest post-cataract infection rate. Trabeculectomy is at a higher risk than cataract because of the intentional fistulization of the anterior chamber.

“Given the demonstrated safety of intracameral moxifloxacin and the potentially devastating consequences of endophthalmitis, intracameral antibiotic prophylaxis after incisional glaucoma surgery should be considered as an alternative routine prophylaxis,” Mitchell said.

Cost-efficacy and the efficacy of intracameral prophylaxis alone should be the subject of further studies.