Francis S. Mah
KOLOA, Hawaii — Despite mounting research, there is no FDA approved intracameral antibiotic for cataract surgery prophylaxis of infection in the United States, Francis S. Mah, MD, said at Hawaiian Eye 2020.
“In terms of intracameral antibiotics in cataract surgery, we have all this great technology,” Mah said. “We are really trying to improve every aspect of cataract surgery to enhance our outcomes and improve our patients’ experience. We have all of these amazing things that we are able to do now and yet we have a problem like endophthalmitis or postoperative infection, which obviously can completely ruin everything we’ve done for these patients.”
The end goal is to eliminate endophthalmitis after cataract surgery completely, and intracameral antibiotics may be able to help with that, he said.
There are some relatively established risks of endophthalmitis that clinicians should be aware of for prevention, including posterior capsule rupture, poor sterile technique, preexisting periocular infections, immunocompromised status and age older than 80 years, according to Mah.
“Prevention is multifactorial — it’s not just the antiseptic and it’s not just the antibiotic,” he said. “There are various different areas you need to focus on to try to prevent endophthalmitis 100%.”
Increasing research is being published regarding use of intracameral antibiotics, but there are questions that should be answered, Mah said. What is the optimal drug, when should it be used, and where should it be used? A large-scale study that would answer these questions is difficult to conduct, however, because the rate of infection is so low.
“What we may have in the future is an FDA approved medication,” he said.
The multicenter, prospective, randomized, controlled TIME study looking at intracameral vs. topical moxifloxacin for endophthalmitis prophylaxis should begin enrollment within the next year, he said. The researchers hypothesize that intracameral moxifloxacin is superior to topical, according to Mah.
“If our hypothesis is proven, this will change postoperative management of endophthalmitis prevention for all cataract surgery patients,” Mah said. – by Alaina Tedesco
Reference: Mah FS. The significance of intracameral antibiotics in cataract surgery. Presented at: Hawaiian Eye 2020; Jan. 18-24, 2020; Koloa, Hawaii.
Disclosure: Mah reports financial relationships with Aerie, Alcon/Novartis, Allergan, Avedro, Avellino Labs, Bausch + Lomb/Valeant, BlephEx, CoDa/Oculonexus, Dompé, EyePoint, Inversa, Iview, Johnson & Johnson Vision, Kala, Mallinckrodt, Novabay, Okogen, Ocular Science, Ocular Therapeutix, Okogen, Omeros, PMN, PolyActiva, RxSight, Shire, Sun Pharma, Sydnexis and TearLab.