Eyeworld

24 | EYEWORLD | SPRING 2026 ASCRS NEWS Contact Melson: Andrew-Melson@dmei.org References 1. Pershing S, et al. Endophthal- mitis after cataract surgery in the United States: a report from the Intelligent Research in Sight Registry, 2013–2017. Ophthalmol- ogy. 2020;127:151–158. 2. Cao H, et al. Risk factors for acute endophthalmitis following cataract surgery: a systematic review and meta-analysis. PLoS One. 2013;8:e71731. 3. Miller KM, et al. Cataract in the Adult Eye Preferred Practice Pattern. Ophthalmology. 2022;129:P1–P126. moxifloxacin has demonstrated a favorable safety profile in intracameral use, with broad antimicrobial coverage and no widely reported cases of retinal toxicity, even when compound- ed from systemic formulations. These factors further support the preferential consideration of moxifloxacin when ICA is used in PCR patients. Another important consideration is anti- microbial stewardship in the context of wide- spread antibiotic prophylaxis. While concerns have been raised regarding the potential for ICA to contribute to local antimicrobial resistance, current evidence suggests that the high intraoc- ular concentrations achieved with intracameral dosing are unlikely to induce clinically mean- ingful resistance. Moreover, the targeted use of ICA in a clearly defined high-risk population, such as patients with PCR, likely mitigates these concerns and supports a favorable risk-benefit balance. Limitations of this meta-analysis should be acknowledged. The majority of included studies were observational in nature, and detailed PCR-specific clinical variables such as vitreous loss, anterior vitrectomy, intraocular lens fixation technique, and wound integrity were inconsistently reported. Although the total sample size was large, the overall incidence of POE remained low, limiting statistical power for subgroup analysis of individual antibiotics. Additionally, visual outcome data following POE were unavailable, precluding assessment of whether ICA influenced final visual prognosis. Some large, randomized trials evaluating ICA in cataract surgery could not be included due to the absence of PCR-specific subgroup data. Despite the limitations, this meta-analysis provides the most comprehensive evidence to date supporting the use of intracameral antibi- otics in cataract surgeries complicated by PCR. For centers that already employ routine ICA, continuation of this practice in PCR cases is well supported. For centers that do not routinely use ICA, selective prophylaxis in PCR patients should be strongly considered as an evidence-based strategy to mitigate the substantially increased risk of postoperative endophthalmitis. Conclusion Posterior capsular rupture is a major intraoper- ative risk factor for postoperative endophthal- mitis, yet evidence guiding targeted prophylaxis in this setting has been limited. This systematic review and meta-analysis demonstrate that intracameral antibiotic prophylaxis significantly reduces the risk of endophthalmitis in patients experiencing PCR. Although the absolute risk reduction is small, the severity of endophthalmi- tis and the substantially lower number needed to treat compared with routine cataract surgery support selective prophylaxis in this high-risk group. Among available agents, intracameral moxifloxacin appears to offer the most favorable balance of efficacy, safety, and phar- macokinetic advantages in PCR cases, while evidence for cefuroxime and vancomycin re- mains limited and tempered by safety concerns. The consistency of findings in this meta-analysis supports the continued use of intracameral an- tibiotics in PCR cases at centers where they are routine and consideration of selective use where they are not. Until PCR-specific prospective data are available, intracameral antibiotic prophylaxis, particularly with moxifloxacin, represents a rational, evidence-based approach to mitigating the elevated risk of postoperative endophthalmitis. continued from page 23 Rom Kandavel, MD, EyeWorld Cataract Editorial Board member, shared what he is looking forward to at the 2026 ASCRS Annual Meeting: "My favorite part of the ASCRS Annual Meeting is bringing valuable information back to my practice and making a meaningful improvement."

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