Abstract
Purpose :
To compare the efficacy of intracameral cefuroxime and moxifloxacin in reducing the rate of acute endophthalmitis after cataract surgery in rural India
Methods :
Prospective, comparative, interventional study. 42 666 eyes (40 006 patients) undergoing cataract surgery in 15 facilities in rural India were pre-selected to use intracameral cefuroxime or moxifloxcin. The results were compared with historical data of post-cataract surgery endophthalmitis recorded 21 months earlier at the same settings.The pre-selected eye centers used intracameral cefuroxime or moxifloxacin irrespective of surgical technique, phacoemulsification or small incision cataract surgery (SICS). Acute post-operative endophthalmitis was defined as one occurring within 6 weeks of cataract surgery. Main outcome measure was occurrence of clinical endophthlamitis, with or without microbiology confirmation.
Results :
Intracameral cefuroxime (17 932 eyes; 42.2%) was used in 5 pre- selected facilities and intracameral moxifloxacin (24 534; 57.8%) was used in 10 facilities. SICS (85.7%; n= 36 413) was more often used cataract surgery technique. Clinical acute endophthalmitis occurred in 15 (0.035%) eyes, a 72.22% reduction from 0.126% in the pre-intracameral control group (p<0.001). The differential incidence of endophthalmitis after intracameral cefuroxime and moxifloxacin was 0.017% (3/17 932) and 0.049% (12/24 534) respectively; this risk difference was statistically significant (p<0.001). None of these patients of endophthalmitis had a breach in posterior capsule or zonular dehiscence.
Conclusions :
There was 3.6- fold decrease in post cataract surgery endophthalmitis in rural India with intracameral antibiotic use. It was 1 in 5977 with intracameral cefuroxime and 1 in 2044 with intracameral moxifloxacin.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.