Eyeworld

EW NEWS & OPINION September 2017 23 8. Arshinoff SA, et al. Dose and administration of intracameral moxifloxacin for prophylaxis of postoperative endophthalmitis. J Cataract Refract Surg. 2016;42:1730–41. Auromox is a 1 ml solution con- taining 5 mg of moxifloxacin that is approved and commercially avail- able in India. It is manufactured by Aurolab, which is a pharmaceutical company affiliated with AECS, and does not require any mixing. All patients in the study received 0.5 mg of Auromox moxifloxacin (0.1 ml) as a direct intracameral injec- tion at the conclusion of surgery. The published study includes cases performed through May 2016. For Dr. Chang's presentation at the 2017 ASCRS•ASOA Symposium & Congress, he updated the data to include all IC moxifloxacin cases performed through March 2017. "We now have 1,087,907 consecu- tive eyes performed during the 51 months starting in January 2013. The endophthalmitis rate was 0.02% in the 555,550 eyes that received IC moxifloxacin prophylaxis, compared to 0.07% in the 532,357 eyes that did not," he reported. Dr. Chang ex- plained that randomized controlled studies for IC antibiotic prophylaxis are extremely expensive and difficult to perform, and their main benefit would be to prevent other potential surgical co-variables aside from the antibiotic from separately reducing the endophthalmitis rate. 7 "What makes the Aravind study so strong is the fact that such a high volume of cases was done in a relatively short period of time," he said. "In addition, to maximize efficiency and cost-effectiveness, all of the cataract surgical protocols are highly standardized at and between every AECS hospital, including use of the same viscoelastics and instruments, and the same sterilizers and draping methods," he added. "For these rea- sons, I think that this is one of the strongest studies to date supporting the efficacy of IC antibiotics in gen- eral, and moxifloxacin in particular." Intracameral moxifloxacin options in the U.S. In the U.S., there is no commer- cially available antibiotic solution that is FDA approved for intraoc- ular prophylaxis. "Many surgeons directly inject moxifloxacin drawn up in the operating room from the unpreserved Vigamox [Novartis, Ba- sel, Switzerland] topical bottle," Dr. Chang said. He recommended a re- view article published in the Journal of Cataract & Refractive Surgery 8 that outlines the method and rationale of this practice. "One must be careful not to use generic topical moxiflox- acin for this purpose, which con- tains adjuvants that are toxic when injected into the eye," he said. Dr. Chang uses a compounding phar- macy for IC moxifloxacin prophy- laxis. "For any compounded drug that is to be injected into the eye, I prefer using a 503B FDA-registered outsourcing pharmacy," he said. "Compared to 503A pharmacies, the 503B outsourcing facilities must meet much more stringent regulato- ry requirements." Shortly after the 2017 ASCRS•ASOA Symposium & Congress, Imprimis Pharmaceuticals (San Diego) began offering a com- pounded moxifloxacin solution in the same concentration (5 mg/1 ml) as Auromox, which was used in the Aravind studies. Dr. Chang said there are also many studies supporting the safety and efficacy of intracameral cefu- roxime prophylaxis in a 1 mg/0.1 ml dose. This can also be obtained through compounding facilities. EW References 1. Chang DF, et al. Prophylaxis of postopera- tive endophthalmitis after cataract surgery: results of the 2007 ASCRS member survey. J Cataract Refract Surg. 2007;33:1801–5. 2. Chang DF, et al. Antibiotic prophylaxis of postoperative endophthalmitis after cata- ract surgery: Results of the 2014 ASCRS member survey. J Cataract Refract Surg. 2015;41:1300–5. 3. Witkin AJ, et al. Postoperative hemorrhagic occlusive retinal vasculitis: Expanding the clin- ical spectrum and possible association with vancomycin. Ophthalmology. 2015;122:1438– 51. 4. Witkin AJ, et al. Vancomycin-associated hemorrhagic occlusive retinal vasculitis: Clini- cal characteristics of 36 eyes. Ophthalmology. 2017;124:583–595. 5. Haripriya A, et al. Efficacy of intracameral moxifloxacin endophthalmitis prophylaxis at Aravind Eye Hospital. Ophthalmology. 2016;123:302–8. 6. Haripriya A, et al. Endophthalmitis reduction with intracameral moxifloxacin prophylaxis: Analysis of 600,000 surgeries. Ophthalmology. 2017;124:768–775. 7. Javitt JC. Intracameral antibiotics reduce the risk of endophthalmitis after cataract surgery: Does the preponderance of the evi- dence mandate a global change in practice? Ophthalmology. 2016;123:226–31. Editors' note: Dr. Chang has no finan- cial interests related to his comments. Contact information Chang: dceye@earthlink.net

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