The effect of intracameral (IC) moxifloxacin prophylaxis in preventing acute post-operative endophthalmitis, a rare but potentially visually devastating surgical complication, remains unstudied for glaucoma surgery.
To analyze the effectiveness of IC moxifloxacin prophylaxis in reducing acute post-operative endophthalmitis after trabeculectomy and combined trabeculectomy/cataract extraction.
A retrospective clinical-registry analysis of patients undergoing either trabeculectomy or trabeculectomy/cataract extraction at Aravind Eye Hospital (AEH) between 2009-2018 (inclusive). Electronic health record data were analyzed before and after implementation of routine IC moxifloxacin, and acute postoperative endophthalmitis rates compared.
During 2015, routine IC moxifloxacin prophylaxis was added in a step-wise fashion throughout AEHs. Date of implementation was used to create Group 1 (without IC moxifloxacin prophylaxis) and Group 2 (with IC moxifloxacin prophylaxis).
The primary outcome was the difference in acute (≤6 weeks) post-operative endophthalmitis between Group 1 vs. Group 2. Review of culture results, visual acuity (VA) and intraocular pressure (IOP) was also performed for cases of endophthalmitis.
38,900 eyes (Group 1) did not receive IC moxifloxacin while 19,086 eyes (Group 2) did. While the rate of non-infectious post-operative complications was not significantly different,1 (0.81% vs. 0.67%, p=0.07), there was a significantly lower rate of acute post-operative endophthalmitis in Group 2 vs. Group 1 (0.03% vs. 0.08%, p=0.03). Patients receiving IC moxifloxacin had an approximately 2.5-times lower odds of infection (OR 0.39 for Group 2 vs. Group 1, 95% CI 0.16-0.95), and almost 4-times lower odds after adjustment for covariates (OR 0.26 for Group 2 vs. Group 1, 95% CI 0.09-0.74). The rate of early post-operative infection after IC moxifloxacin introduction was lower for patients undergoing both trabeculectomy alone (0.09 to 0.03%, p=0.27) and combined trabeculectomy/cataract extraction (0.08 to 0.03%, p=0.06). While most cultures yielded no growth, there was no staphylococcus or gram-negative growth for patients in Group 2 who received IC moxifloxacin.
and relevance: IC moxifloxacin prophylaxis was associated with a nearly 4-fold lower rate of early postoperative endophthalmitis in patients undergoing trabeculectomy or combined trabeculectomy/cataract extraction.

Copyright © 2020. Published by Elsevier Inc.

References

PubMed