Endophthalmitis reduction with intracameral moxifloxacin in eyes with and without surgical complications: Results from 2 million consecutive cataract surgeries

Abstract

Purpose: To analyze the posterior capsule rupture (PCR) rates among staff and trainee cataract surgeons, and the postoperative endophthalmitis (POE) rates in uncomplicated and complicated eyes both with and without intracameral moxifloxacin prophylaxis (ICMP).

Setting: Ten regional Aravind Eye Hospitals in India.

Design: Retrospective multicenter clinical registry within a single hospital network.

Methods: POE rates with and without ICMP were statistically compared for all eyes and separately for trainees versus staff, for phacoemulsification versus manual small-incision cataract surgery (M-SICS), and for a subgroup of eyes complicated by PCR or requiring secondary surgery.

Results: All cataract surgeries (2 062 643) performed during the 8-year period from 2011 to 2018 at the 10 regional Aravind Eye hospitals were included in the analysis. With ICMP, the overall POE rate declined from 692 (0.07%) of 993 009 eyes to 185 (0.02%) of 1 069 634 eyes (P < .001). This was independently significant for phacoemulsification and for M-SICS (P < .001). The overall PCR rate was 28 352 (1.37%) of 2 062 643 eyes, and it was statistically higher for trainees irrespective of surgical method (P < .001). Both staff and trainee surgeons had higher PCR rates with phacoemulsification than with M-SICS (P < .001). Absent ICMP, PCR increased the overall POE rate by more than 7-fold to 63 (0.43%) of 14 505 eyes. ICMP reduced the POE rate after PCR to 25 (0.18%) of 13 847 eyes (P = .002). This ICMP benefit was separately significant for both M-SICS (0.54% vs 0.26%, P = .01) and phacoemulsification (0.29% vs 0.06%, P = .005). The POE rate was especially high after secondary IOL implantation (0.90% without ICMP vs 0.34% with ICMP; P = .10).

Conclusions: ICMP reduced the POE rate overall, with phacoemulsification, with M-SICS, and in eyes with PCR.