Corneal decompensation following intrastromal hydration of corneal wounds with 0.5% moxifloxacin

Many ophthalmologists have adopted the off-label practice of injecting moxifloxacin intracamerally and into the corneal stroma around the incision at the conclusion of surgery for endophthalmitis prophylaxis. The safety and efficacy of intracameral moxifloxacin for routine cataract surgery has been investigated and endorsed by multiple authors, but to our knowledge, potential complications from intrastromal hydration of clear corneal incisions with 0.5% preservative-free moxifloxacin have not been documented. Two consecutive patients underwent surgery for traumatic ocular injuries. The first patient underwent removal of an intralenticular metallic foreign body with cataract surgery and intraocular lens placement. The second patient underwent repair of an extensive corneoscleral laceration with uveal prolapse. Both patients developed toxic anterior segment syndrome and corneal decompensation within 4 days of intracameral injection and intrastromal hydration of corneal wounds with 0.5% preservative-free topical-formulation moxifloxacin for endophthalmitis prophylaxis following surgery. Surgeons should avoid the use of undiluted 0.5% topical-formulation moxifloxacin drugs for intrastromal hydration of clear corneal incisions following intracameral administration to decrease the risk for corneal decompensation and toxic anterior segment syndrome. We recommend using only 0.1% compounded formulations for both intrastromal and intracameral injections or avoiding intrastromal injection altogether.