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William Greig Mitchell, Lisa Tom, Indira Durai, Sindhushree Rajagopal, Menaka Vimalanathan, Rengaraj Venkatesh, Nazlee Zebardast, Srinivasan Kavitha; Effectiveness of Intracameral Moxifloxacin Endophthalmitis Prophylaxis for Trabeculectomy at Aravind Eye Hospitals. Invest. Ophthalmol. Vis. Sci. 2020;61(7):1420.
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The effect of intracameral (IC) moxifloxacin prophylaxis after trabeculectomy has not been previously studied. In 2015, Aravind Eye Hospitals (AEH) instituted a standardized IC moxifloxacin policy for trabeculectomy and combined trabeculectomy with cataract extraction, providing a unique opportunity to analyze the effectiveness of IC moxifloxacin in reducing acute postoperative infection after trabeculectomy.
This is a retrospective clinical registry analysis of all patients undergoing either trabeculectomy or trabeculectomy with cataract extraction at AEH from January 2009 to December 2018. Electronic health record data were analyzed before and after policy implementation. Acute (<6 weeks) postoperative endophthalmitis rates were compared.
Overall, 38,900 eyes (Group 1) did not receive IC moxifloxacin while 19,086 eyes (Group 2) did. Combined trabeculectomy with cataract extraction accounted for >80% of total surgeries.While non-infectious complications were significantly higher for Group 2 vs. Group 1 (1.72% vs. 1.01%, p<0.01), there was a significant decline in early post-operative infection in those that received IC Moxifloxacin. 30 eyes in Group 1 (0.08%) and 6 eyes in Group 2 (0.03%) were diagnosed with acute post-operative endophthalmitis (p=0.038). After the introduction of IC moxifloxacin, there was an approximately 2.5 times reduced odds of infection (OR 0.41 for Group 2 vs. 1, 95% CI 0.17-0.98). The same association was found after adjustment for age and sex (OR 0.27 for Group 2 vs. 1, 95% CI 0.10-0.77).The rate of early post-operative infection after IC moxifloxacin decreased for patients undergoing either trabeculectomy alone (0.09 to 0.03%, p=0.27) or combined trabeculectomy with cataract extraction (0.07 to 0.03%, p=0.08). There was no association between infection rate and surgery type, location, or payment type.While most cultures yielded no growth, staphylococcus were the predominate causative organisms identified.
IC moxifloxacin prophylaxis achieved a nearly 2.5-fold reduction in early postoperative endophthalmitis in patients undergoing trabeculectomy or combined trabeculectomy with cataract extraction, suggesting IC moxifloxacin should be considered with either procedure. This study was strengthened by the high case volume across a single hospital network, but limited by a relatively long time-frame and retrospective nature.
This is a 2020 ARVO Annual Meeting abstract.
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