Prospective Comparison of 1–Day vs 1–Hour Pre–Operative Moxifloxacin Prophylaxis for Intraocular Surgeries

Abstract

 

Purpose:

 

To compare the efficacy of an one–hour versus one–day application of topical moxifloxacin in killing conjunctival bacterial flora in patients undergoing intraocular surgery.

 

Methods:

 

Prospective, masked non–randomized evaluation of 58 eyes of 29 patients scheduled to undergo intraocular surgery (cataract, glaucoma or corneal transplant). Cultures were taken from the palpebral conjunctival sacs in both eyes at baseline (T0). All patients were instructed to instill topical moxifloxacin into surgical eye 4 times a day starting 1 day prior to surgery. On the day of surgery, cultures were taken from both eyes (T1) where the surgical eye received antibiotics for 1 day prior and the fellow non–surgical eye is untreated. One hour prior to surgery, both eyes received 3 additional doses of antibiotic, given 5 minutes apart. Cultures were obtained 45 minutes following the last dose of antibiotic (T2), where the surgical eye received 1–day and 1–hour of antibiotics, and the non–surgical eye received only 1–hour of antibiotic. Culture swabs were inoculated onto blood agar, chocolate agar and Septi–chek culture broth and incubated at 37°C for 3, 7 and 5 days respectively. The individuals obtaining the cultures and analyzing the results were masked with regard to surgical/non–surgical eye groups.

 

Results:

 

For blood agar cultures, the percent positive cultures for surgical/non–surgical eyes is 72% / 76% at T0, 24% / 41% at T1 and 14% / 38% at T2. For chocolate agar, the percent positive cultures for surgical/non–surgical eyes is 48% / 52% at T0, 21% / 41% at T1 and 24% / 48% at T2. For Septichek broth cultures, the percent positive cultures for surgical /non–surgical eyes is 83% / 59% at T0, 55% / 55% at T1 and 24% / 52% at T2.

 

Conclusions:

 

The application of topical moxifloxacin for only one hour does not appear to be effective in eliminating or reducing conjunctival bacterial flora. At least one day of topical moxifloxacin may be required for demonstrate efficacy in bacterial killing in vivo.  

 

Keywords: endophthalmitis • bacterial disease • antibiotics/antifungals/antiparasitics