Eyeworld

EW CATARACT 35 March 2019 to ascribe a syndrome like this to an intracameral injection after a prolonged period, such delays have been seen in other syndromes, Dr. Mamalis noted. For example, with hemorrhagic occlusive retinal vascu- litis (HORV) there is a delayed onset of the severe inflammatory reaction, which may not occur until a couple of weeks after surgery. "The fact that it's delayed doesn't mean that you can't ascribe it to the moxifloxacin, but there's no proof," he said. "It's hard to ascribe any significance to a one-time occurrence when we're still not sure that the antibiotic is the cause." On the other hand, you can't dismiss something because there has been a large amount of an agent used without an issue, Dr. Mamalis stressed, adding that with HORV, there were those who proclaimed that vancomycin had been used for 20,000 cases and this had never been seen. Overall, when it comes to keeping endophthalmitis at bay, Dr. Mamalis thinks that moxifloxacin has been shown to be a valuable medication. The intracameral dosing of the preservative-free moxifloxa- cin in multiple studies has not been shown to cause any form of toxicity and certainly nothing like this BAIT syndrome, he stressed. "With just one case, we still don't know for sure if it's related to the antibiotic, but I would not recommend that surgeons consider stopping moxi- floxacin," Dr. Mamalis said. "I think it's a valuable antibiotic to use, and I think study after study has shown that it's safe in the small dose that we use in the anterior chamber fol- lowing surgery." EW References 1. Arshinoff SA, et al. Intracameral cefuroxime, moxifloxacin, and vancomycin: their doses, abatement rates, and relative efficacies in preventing postoperative endophthalmitis. Presented at the 2018 American Academy of Ophthalmology Annual Meeting. 2. Arshinoff SA, Modabber M. Dose and ad- ministration of intracameral moxifloxacin for prophylaxis of postoperative endophthalmitis. J Cataract Refract Surg. 2016;42:1730–1741. 3. Light JG, Falkenberry SM. Unilateral bilat- eral acute iris transillumination-like syndrome after intracameral moxifloxacin injection for intraoperative endophthalmitis prophylaxis. JCRS Online Case Reports. 2019;7:3–5. 4. Sandhu HS, et al. Oral fluoroquinolones and the risk of uveitis. JAMA Ophthalmol. 2016; 134:38–43. Editors' note: Dr. Arshinoff has finan- cial interests with Entod International (Mumbai, India). Dr. Mamalis has no financial interests related to his comments. Contact information Arshinoff: ifix2is@gmail.com Mamalis: nick.mamalis@hsc.utah.edu Injectable Formulations 844.446.6979 *For professional use only. Imprimis Pharmaceuticals specializes in customizing medications to meet unique patient and practitioner needs. No compounded medication is reviewed by the FDA for safety or e•icacy. Imprimis Pharmaceuticals does not compound copies of commercially available products. References available upon request. ImprimisRx, Tri-Moxi, Dex-Moxi, Dex-Moxi-Ketor, and MKO Melt are trademarks of Imprimis Pharmaceuticals, Inc. ©2019 Imprimis Pharmaceuticals, Inc. All rights reserved. IMPO0359 01/19 As of 01.20.19 Other Formulations For All Your Surgical Needs From our FDA-Registered Outsourcing Facility Order at: www.order.imprimisrx.com Tri-Moxi® (Triamcinolone acetonide and moxifloxacin hydrochloride) 15mg/1mg/mL Dex-Moxi® (Dexamethasone and moxifloxacin hydrochloride) 1mg/5mg/mL Dex-Moxi-Ketor™ (Dexamethasone, moxifloxacin hydrochloride and ketorolac) 1mg/0.5mg/0.4mg/mL Moxifloxacin 5mg/mL and 1mg/mL Hyaluronidase 175 units/mL MKO Melt® Sublingual Lemon (Midazolam, ketamine HCL and ondansetron) (3/25/2) mg Providone Iodine 5% Lidocaine/ Epinephrine in BSS (PF/SF) (0.75/0.025)% Phenylephrine/Lidocaine (PF/SF) (1.5/1)% Topical Formulations Steroid, Antibiotic, NSAID Steroid, Antibiotic Steroid, NSAID

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