Incidence of post-traumatic endophthalmitis following repaired open globe injury: impact of prophylactic intracameral moxifloxacin.

Abstract

Purpose : Intracameral moxifloxacin (ICM) reduces endophthalmitis in cataract surgery, but there is limited evidence for ICM as prophylaxis for post-traumatic endophthalmitis after repaired open globe injury (OGI). We performed a retrospective, consecutive, and comparative cohort study of patients operated in an Ophthalmology department between 2002 and 2023. This study aims to assess if ICM is more effective than povidone-iodine (PI) alone in reducing the incidence of post-traumatic endophthalmitis after repaired OGI.

Methods : Patients were divided into two groups: those operated between 05/Dec/2002 and 30/Mar/2012 received PI prophylaxis (PI group). Those operated between 30/Dec/2013 and 26/May/2023 received PI plus ICM at surgery end (ICM group). All ages and genders undergoing repair surgery at our institution were included. Exclusion criteria included: other intraocular antibiotic prophylaxis, pre-surgical endophthalmitis, enucleation, or surgery performed elsewhere. The definition of endophthalmitis for this study was a clinical finding of severe intraocular inflammation associated with either the presence of hypopyon and/or vitritis.

Results : A total of 424 eyes of 424 patients were included, 294 in ICM group and 130 in PI group. Male gender was 85.7% and 90.8% in the ICM and PI groups (p= 0.150). Mean age was 28.36 ± 17.55 and 24.32 ± 16.55 in the ICM and PI groups (p=0.025). The percentage of age under 18 was 33.1% and 38.5% in ICM and PI groups (p= 0.275). There was no significant difference in the mechanism between groups (p= 0.185). Intraocular foreign body was observed in 29 (9.9%) and 4 (3.1%) in ICM and PI groups (p=0.016). The number of traumatic cataracts with an intact capsule was 63 (21.4%) and 48 (36.9%) in the ICM and PI groups (p=0.001). The number of cataracts with ruptured capsule was 79 (26.9%) and 3 (2.3%) in ICM and PI groups (p=0.000). The percentage of cataract removal during the surgery was similar between groups (p=0.795). Similar preoperative visual acuity was observed in both groups (p= 0.341). Post-traumatic endophthalmitis was significantly lower in ICM (2, 0.7%) than in PI (5, 3.8%) (p= 0.018) group.

Conclusions : The addition of ICM at the end of surgery significantly reduces the incidence of post-traumatic endophthalmitis after OGI when compared with PI alone.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.