+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Endophthalmitis prophylaxis by intracameral antibiotics: In vitro model comparing vancomycin, cefuroxime, and moxifloxacin



Endophthalmitis prophylaxis by intracameral antibiotics: In vitro model comparing vancomycin, cefuroxime, and moxifloxacin



Journal of Cataract and Refractive Surgery 43(6): 833-838



To compare the efficacy of intracameral vancomycin, cefuroxime, and moxifloxacin on postoperative bacterial endophthalmitis rates. Norwalk Hospital, Norwalk, Connecticut, USA. Experimental study. Bacteria and intraocular lenses (IOLs) were incubated with vancomycin, cefuroxime, moxifloxacin, or combinations. Antibiotic concentrations were high, corresponding to clinical maximum intracameral doses (1.0 mg vancomycin or cefuroxime, 0.5 mg moxifloxacin), or low (one third of clinical maximum dose). The following bacteria were isolated from patients with endophthalmitis: 18 strains including 6 staphylococci, 6 streptococci, 3 pseudomonad, and 3 propionibacteria. Samples were diluted by half every 2 hours to model the half-life of intracameral antibiotics. At 24 hours, samples were vortexed to shake bacterial biofilms loose from the IOLs. The bacterial broth was plated and colonies were counted 24 hours later. Efficacy against staphylococci was concentration dependent; all antibiotics were effective at high concentrations, while low concentrations were in general ineffective. Streptococci and propionibacteria were nearly eliminated by all antibiotics at low concentrations. Pseudomonads were most effectively treated by high-dose moxifloxacin and its combinations. Broadest coverage against common pathogens should be obtained by high-dose moxifloxacin (0.5 mg intracameral). Submaximum dosing, which could occur if aqueous is released to lower intraocular pressure after injection, compromises the efficacy against staphylococci and pseudomonads. All antibiotics, even at low doses, were effective against streptococci and propionibacteria, suggesting that many of the worst endophthalmitis outcomes could be prevented by intracameral use of any of the 3 antibiotics used in this study.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 059680096

Download citation: RISBibTeXText

PMID: 28732619

DOI: 10.1016/j.jcrs.2017.04.028


Related references

Intracameral cefuroxime and moxifloxacin used as endophthalmitis prophylaxis after cataract surgery: systematic review of effectiveness and cost-effectiveness. Clinical Ophthalmology 8: 1515-1522, 2014

Intracameral moxifloxacin: a safe option for endophthalmitis prophylaxis? In vitro safety profile for intraocular application. Der Ophthalmologe 107(8): 720-727, 2010

Using intracameral cefuroxime as a prophylaxis for endophthalmitis. Community Eye Health 21(65): 11, 2008

Endophthalmitis prophylaxis with intracameral cefuroxime in South Africa. Journal of Cataract and Refractive Surgery 38(11): 2054, 2012

Prophylaxis of postoperative endophthalmitis with intracameral cefuroxime: a five years' experience. Archivos de la Sociedad Espanola de Oftalmologia 84(2): 85-89, 2009

Reevaluating intracameral cefuroxime as a prophylaxis against endophthalmitis after cataract surgery. Journal of Cataract and Refractive Surgery 41(5): 1125-1126, 2015

Intracameral cefuroxime: prophylaxis of postoperative endophthalmitis after cataract surgery. Drugs 73(2): 179-186, 2013

Efficacy of Intracameral Moxifloxacin Endophthalmitis Prophylaxis at Aravind Eye Hospital. Ophthalmology 123(2): 302-308, 2016

Cohort study of intracameral moxifloxacin in postoperative endophthalmitis prophylaxis. Ophthalmology and Eye Diseases 6: 1-4, 2014

Endophthalmitis Reduction with Intracameral Moxifloxacin Prophylaxis: Analysis of 600 000 Surgeries. Ophthalmology 124(6): 768-775, 2017

Safety of intracameral moxifloxacin for prophylaxis of endophthalmitis after cataract surgery. Journal of Cataract and Refractive Surgery 34(7): 1114-1120, 2008

Dose and administration of intracameral moxifloxacin for prophylaxis of postoperative endophthalmitis. Journal of Cataract and Refractive Surgery 42(12): 1730-1741, 2016

Reevaluating intracameral cefuroxime as a prophylaxis against endophthalmitis after cataract surgery in India. Journal of Cataract and Refractive Surgery 41(2): 393-399, 2015

Endophthalmitis after cataract surgery despite intracameral antibiotic prophylaxis with licensed cefuroxime. Journal of Cataract and Refractive Surgery 42(9): 1318-1323, 2016

Safety and efficacy of intracameral moxifloxacin injection for prophylaxis of endophthalmitis after phacoemulsification. Arquivos Brasileiros de Oftalmologia 80(3): 165-167, 2017