Eyeworld

DECEMBER 2021 | EYEWORLD | 31 Contact Chang: dceye@earthlink.net prevent Endophthalmitis) study would test the efficacy of intracameral moxifloxacin in reducing the cataract surgical endophthalmitis rate compared to using topical moxifloxacin alone. Although some ophthalmologists have touted the benefits of "drop-free" cataract surgery, pars plana or transzonular intravitreal antibiotic injection was reported by less than 3% of all survey respondents. There was a dramatic shift in antibiotic preference among those employing intraocular prophylaxis. Moxifloxacin preference more than doubled from 33% in 2014 to 73%, while van- comycin preference fell to 2%. Among American surgeons, moxifloxacin preference was up to 83% (31% in 2014), while vancomycin prefer- ence fell from 52% in 2014 to 6%. This shift is presumably due to the association of vancomy- cin with hemorrhagic occlusive retinal vasculitis and the American Academy of Ophthalmology Cataract Preferred Practice Pattern panel and the FDA discouraging its use for routine surgical prophylaxis. 6 Increasing preference for moxi- floxacin would be supported by recently pub- lished population data on the safety and efficacy of moxifloxacin prophylaxis for endophthalmitis at the Aravind Eye Hospital. 7 A commercial intraocular product was used by only 5% of global respondents injecting IC moxifloxacin, with the remainder evenly divided between using compounded moxifloxacin (49%) or topical Vigamox (moxifloxacin, Novartis) (46%) as the source. Those who knew what moxifloxacin concentration they employed were equally divided between the 0.5% and 0.1% concentrations. The percentage of respondents who are not using intracameral antibiotics continues to decrease. They cited compounding risk (66%), cost (42%), and being unconvinced of the need (48%) as reasons (Table 2). However, 80% of all respondents now think that it is important to have an approved commercial antibiotic for direct intracameral injection compared to 75% in 2014 and 54% in 2007. If a reasonably priced commercial solution was available, intracam- eral antibiotic adoption would increase to 93% of respondents, compared to 83% and 82% in the two prior surveys. ASCRS and the U.S. Veterans Health Administration are working to organize a multicenter, prospective randomized clinical trial in the U.S. with the goal of getting a commercial antibiotic solution approved. The TIME (Topical vs. Intracameral Moxifloxacin to Table 1. Perioperative use of antibiotic prophylaxis Regimen 2021 2014 2007 Perioperative topical antibiotics 82% (987/1206) 90% 91% Preoperative topical antibiotics 73% (882/1206) 85% 88% Postoperative topical antibiotics 86% (1030/1204) 97% 98% Intracameral antibiotics 66% (802/1208) 50% 30% Irrigation vs. direct injection (if using): Direct injection 95% (764/802) 84% 52% Irrigation bottle 5% (38/802) 16% 48% Table 2. Opinions about intracameral antibiotic prophylaxis Source (all): David F. Chang, MD Importance of approved commercial antibiotic? 2021 2014 2007 Important 80% (962/1204) 75% 54% Not important 7% (88/1204) 9% 11% Not sure 13% (154/1204) 16% 35% Would still not use intraocular antibiotic* 7% (82/1204) 17% 18% Why not using IC antibiotic?* 2021 2014 2007 Mixing/compounding risk 66% (251/382) 49% 45% Cost 32% (122/382) 19% 17% Not convinced of need 48% (182/382) 65% 89% *Asked of 382 respondents who weren't using intracameral antibiotic; the percentages total >100 because respondents could check more than one reason

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