Efficacy of intracameral moxifloxacin in prevention of postcataract surgery endophthalmitis: randomized control trial

PURPOSE: To study the efficacy of intracameral moxifloxacin 0.5% in prevention of postcataract surgery endophthalmitis. SETTINGS: 3 tertiary eye centers of northern India. DESIGN: Multicentric randomized clinical study. METHODS: 60 000 eyes undergoing phacoemulsification with intraocular lens (IOL) implantation were randomized in 2 groups in 1:1 format from January 2018 to June 2024. Group 1 received intracameral moxifloxacin (cases), whereas group 2 did not receive intracameral antibiotics (control). Any case of endophthalmitis in the postoperative period up to 6 weeks in both groups was documented and managed according to routine protocols. RESULTS: The endothelial cell counts were comparable preoperatively ( P = .18) and postoperatively ( P = .54). 6 eyes (0.02%) in the intracameral moxifloxacin group developed endophthalmitis as compared with 16 eyes in the control group (0.05%) ( P = .04). The odds of developing endophthalmitis were 2.5 times lower with the usage of intracameral moxifloxacin. The mean time of presentation of endophthalmitis in groups 1 and 2 was 32.26 ± 23.42 days and 23.52 ± 13.91 days, respectively. 8 cases (8/22; 36.36%) were culture-positive of which one was fungus (n = 1/8; 12.5%), while rest were bacteria (n = 7/8; 87.5%). Coagulase-negative Staphylococcus was the most commonly isolated microorganism (n = 4; 50%). Resistance to fluoroquinolones was higher for ciprofloxacin (5/7) and gatifloxacin (3/7) than moxifloxacin (2/7). At 3 months, 17 of 22 eyes (77.27%) responded to treatment and endophthalmitis resolved by 3 months. However, 1 eye in group 1 and 3 eyes in group 2 developed phthisis (4/22; 18.18%). CONCLUSIONS: Intracameral moxifloxacin is safe and effective in preventing postcataract surgery acute bacterial endophthalmitis.