To aid the
cataract surgeon's understanding of rational approaches to antimicrobial prophylaxis and place the European Society of
Cataract & Refractive Surgeons (ESCRS) postoperative
endophthalmitis study in perspective, a review was conducted of published and unpublished data on intracameral
antibiotic use during
cataract surgery and the antimicrobial efficacy, pharmacodynamics, ocular penetration, and safety of
moxifloxacin. The ESCRS-sponsored study of postoperative
endophthalmitis prophylaxis reported rates of presumed infectious postoperative
endophthalmitis of 0.07% with intracameral
cefuroxime treatment and 0.34% in control groups. Postoperative
endophthalmitis after
cefuroxime use was mostly due to
cefuroxime-resistant gram-positive bacteria. Intracameral
cefuroxime also requires extemporaneous compounding, has short-term stability, and carries a risk for
hypersensitivity.
Moxifloxacin, a fourth-generation
fluoroquinolone, has potent and rapid bactericidal activity against the most common gram-positive postoperative
endophthalmitis pathogens, has excellent ocular penetration after
topical administration, and is available in a self-preserved ophthalmic formulation that has been shown safe and effective in preventing
endophthalmitis when administered intracamerally in an animal model. Available data suggest that the optimum
antibiotic regimen and route of delivery for
cataract surgery antimicrobial prophylaxis require further study.
Moxifloxacin offers many theoretical advantages that make it an attractive first-line choice for topical use and of interest for intracameral administration.