Efficacy of Intracameral Moxifloxacin Endophthalmitis Prophylaxis at Aravind Eye Hospital

Ophthalmology. 2016 Feb;123(2):302-308. doi: 10.1016/j.ophtha.2015.09.037. Epub 2015 Oct 30.


Purpose: To compare the rate of postoperative endophthalmitis before and after initiation of intracameral (IC) moxifloxacin for endophthalmitis prophylaxis in patients undergoing cataract surgery.

Design: Retrospective, clinical registry.

Participants: All charity and private patients (116 714 eyes) who underwent cataract surgery between February 15, 2014, and April 15, 2015, at the Madurai Aravind Eye Hospital were included. Group 1 consisted of 37 777 eyes of charity patients who did not receive IC moxifloxacin, group 2 consisted of 38 160 eyes of charity patients who received IC moxifloxacin prophylaxis, and group 3 consisted of 40 777 eyes of private patients who did not receive IC moxifloxacin.

Methods: The electronic health record data for each of the 3 groups were analyzed, and the postoperative endophthalmitis rates were statistically compared. The cost of endophthalmitis treatment (groups 1 and 2) and the cost of IC moxifloxacin prophylaxis (group 2) were calculated.

Main outcome measures: Postoperative endophthalmitis rate before and after initiation of IC moxifloxacin endophthalmitis treatment cost.

Results: Manual, sutureless, small incision cataract surgery (M-SICS) accounted for approximately all of the 75 937 cataract surgeries in the charity population (97%), but only a minority of the 40 777 private surgeries (21% M-SICS; 79% phacoemulsification). Thirty eyes in group 1 (0.08%) and 6 eyes in group 2 (0.02%) were diagnosed with postoperative endophthalmitis (P < 0.0001). The group 3 endophthalmitis rate was 0.07% (29 eyes), which was also higher than the second group's rate (P < 0.0001). There were no adverse events attributed to IC moxifloxacin in group 2. The total cost of treating the 30 patients with endophthalmitis in group 1 was virtually identical to the total combined cost in group 2 of routine IC moxifloxacin prophylaxis and treatment of the 6 endophthalmitis cases.

Conclusions: Routine IC moxifloxacin prophylaxis achieved a highly significant, 4-fold reduction in postoperative endophthalmitis in patients undergoing M-SICS. Compared with previous studies, having such a high volume of patients undergoing surgery during a relatively short 14-month time period strengthens the conclusion. This study provides further evidence that moxifloxacin is an effective IC prophylactic antibiotic and suggests that IC antibiotics should be considered for M-SICS and phacoemulsification.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Anterior Chamber / drug effects*
  • Anti-Bacterial Agents / economics
  • Anti-Bacterial Agents / therapeutic use*
  • Antibiotic Prophylaxis*
  • Cataract Extraction*
  • Charities
  • Drug Costs
  • Electronic Health Records / statistics & numerical data
  • Endophthalmitis / epidemiology*
  • Endophthalmitis / microbiology
  • Endophthalmitis / prevention & control
  • Eye Infections, Bacterial / epidemiology*
  • Eye Infections, Bacterial / microbiology
  • Eye Infections, Bacterial / prevention & control
  • Fluoroquinolones / economics
  • Fluoroquinolones / therapeutic use*
  • Health Care Costs
  • Hospitals, Private
  • Hospitals, Public
  • Hospitals, Special
  • Humans
  • India / epidemiology
  • Male
  • Middle Aged
  • Moxifloxacin
  • Ophthalmology
  • Postoperative Complications
  • Registries
  • Retrospective Studies


  • Anti-Bacterial Agents
  • Fluoroquinolones
  • Moxifloxacin