Abstract
Purpose :
Intracameral moxifloxacin has seen increased use for the prophylaxis of post-cataract endophthalmitis. A number of studies have also explored the therapeutic potential of intravitreal moxifloxacin in vitro and in animal models. This study examines outcomes of triple therapy with intravitreous vancomycin, ceftazidime, and moxifloxacin for endophthalmitis in vivo. Moxifloxacin offers broad-spectrum antimicrobial coverage and, importantly, use of moxifloxacin with ceftazidime double covers Gram-negative organisms.
Methods :
This is a single-center retrospective review of all patients treated with the abovementioned intravitreal antibiotics from January 2009 to August 2019. Patients were included for analysis if endophthalmitis occurred within 90 days of cataract surgery and were excluded for less than 3 months of follow-up. Patients could receive topical or systemic antibiotics and steroids at the discretion of the treating physician. Primary outcomes were 3-month and final visual acuities.
Results :
Twenty-four patients were treated with intravitreal vancomycin, ceftazidime, and moxifloxacin for post-cataract endophthalmitis at our institution. Median follow-up was 9 months, with 17 of 24 patients completing at least 3 months of follow-up. Among these patients, all were initially treated with tap and inject, and four underwent vitrectomy within 72 hours. Average LogMAR visual acuities at presentation, after 3 months, and at final follow-up were 1.98 (~HM), 0.56 (~20/70), and 0.46 (~20/60), respectively (p<0.0001 for each comparison). 71% of patients had a Snellen visual acuity better than 20/40 at final follow-up. Only two patients who completed 3 months of follow-up had a final visual acuity worse than 20/100. One of these two patients grew Bacillus species from culture and the other suffered a retinal detachment three years after initial presentation and had an acuity of 20/30 prior to detachment. No retinal vascular toxicity was noted in any case.
Conclusions :
Moxifloxacin was well tolerated as an adjunct therapy for the treatment of bacterial endophthalmitis with no noted toxicities at 160 micrograms/0.1mL. Visual acuity outcomes compared favorably to outcomes for post-cataract endophthalmitis reported in the literature. Further study is merited to assess whether adjunct therapy with moxifloxacin may lead to improved visual outcomes in an era of increasing antimicrobial resistance.
This is a 2020 ARVO Annual Meeting abstract.