Eyeworld

EW RESIDENTS 72 March 2019 EyeWorld journal club by the residents of the University of Illinois at Chicago and William Mieler, MD In Australia, Au et al. performed a retrospective cohort study on 14,805 cataract surgeries before and after the introduction of IC van- comycin. They found a nine-fold reduction in the incidence of POE (P<0.0001). 4 However, a recent re- port published by a joint American Society of Cataract and Refractive Surgery/American Society of Retina Surgeons task force found 36 cases of hemorrhagic occlusive retinal vasculitis associated with prophylac- tic IC vancomycin use after uncom- plicated cataract surgery. 5 Because of this potentially catastrophic complication, use of IC vancomycin fell out of favor with some cataract surgeons. Finally, preservative-free iso- tonic IC moxifloxacin 0.5% was found in a large retrospective study including 600,000 cases by Har- ipriya et al. to reduce the rate of POE after phacoemulsification by nearly six-fold. 6 Thus, for Ameri- can cataract surgeons interested in the use of IC antibiotics to prevent POE, moxifloxacin is an appealing and available option. However, no randomized control trials had been performed until the article of inter- est we present here. "Safety and efficacy of intraca- meral moxifloxacin for prevention of post-cataract endophthalmitis: a randomized controlled clinical trial" was the first prospective, randomized, controlled clinical trial to evaluate the safety and efficacy of IC moxifloxacin to prevent POE following cataract surgery. It was a single-site, prospective, randomized Phase 3 trial with partial masking. This contrasts with prior studies, which were predominantly ret- rospective, non-randomized, and observational in nature. Melega and colleagues com- pared the outcomes of 3,640 eyes from 3,640 patients who were randomized 1:1 to receive either IC moxifloxacin or no IC injection at the conclusion of phacoemulsifica- tion cataract surgery. Both groups received the standard postoperative drop regimen including topical moxifloxacin. Fewer than 1% of pa- tients were lost to follow up in each group. The authors reported similar preoperative demographics between groups, as there were no significant differences in gender, age, or preop- erative best corrected visual acuity (BCVA). However, some relevant preoperative factors were not re- ported. The incidence of blepharitis, presence of ocular surface disease, prior intraocular surgery, presence of glaucoma drainage devices, and hospital location of surgery were not reported for inclusion in the evaluation. The primary outcome of the study was the rate of POE by postop week 6. The intervention included a standard formulation of moxi- floxacin drawn up into a 0.5 mL syringe with 0.03 mL injected via the sideport incision. The antibiot- ic was considered inherently safe due to the absence of preservatives, near-neutral pH, and isotonicity. The data show a statistically signif- icant reduction in the rate of POE from 0.38% in the control group vs. 0.05% in the intervention group P ostoperative endophthal- mitis (POE) is a rare but serious potential compli- cation of cataract surgery with often devastating visual outcomes. In an effort to re- duce the incidence of POE, cataract surgeons have increasingly utilized prophylactic intracameral (IC) anti- biotics, the most common of which include vancomycin, moxifloxacin, and cefuroxime. The utility of IC antibiotics has been recognized in the Preferred Practice Pattern guide- lines from the American Academy of Ophthalmology. 1 Despite the significant reduction in infection rates with IC antibiotics, widespread adoption remains stagnant, limited both by antibiotic availability and concern regarding dilution errors and contamination. 2,3 The strongest data supporting the use of IC antibiotics are from the European Society of Cataract & Refractive Surgeons, which in 2007, published the results of the first large prospective, randomized, multicenter study that demonstrated IC cefuroxime to be associated with a 4.92-fold decrease (95% confidence interval 1.97–12.9) in the risk of POE. 2 Since then, the use of prophy- lactic IC cefuroxime has been adopt- ed in Europe where IC cefuroxime is commercially available (Aprokam, Thea Pharmaceuticals, Clermont-Fer- rand, France). This formulation is not currently available in the U.S. or in much of the rest of the world. Review of "Safety and efficacy of of post-cataract endophthalmitis: William Mieler, MD, director of residency and vitreoretinal fellowship training, Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago Critics of intraocular antibiotic prophylaxis often point to the lack of enough randomized clinical evidence. I asked the University of Illinois at Chicago residents to re- view this relatively small random- ized trial looking at intracameral moxifloxacin prophylaxis that is published in this month's JCRS. —David F. Chang, MD, EyeWorld journal club editor University of Illinois at Chicago residents; top row, from left: third-year residents Lindsay Machen, MD, Wyatt Messenger, MD, Alisa Thavikulwat, MD, Grace Dunbar, MD; middle row, from left: second-year residents Levi Kanu, MD, Judy Chen, MD, Priyanka Chhadva, MD, Kelley Bohm, MD, Talisa de Carlo, MD, Daniel Oh, MD; bottom row, from left: first-year residents Nita Valikodath, MD, Emily Cole, MD, Lawrence Geyman, MD, Samuel Burke, MD, Rajvi Mehta, MD Source: University of Illinois at Chicago

• Blank Page
• Blank Page (1)