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van Rooij J, Nolte K, van de Vondervoort F, Lekkerkerk S, Bourgonje V, Wubbels R. Prophylactic Intracameral Antibiotics and Endophthalmitis After Cataract Surgery. JAMA Ophthalmol 2024; 142:699-706. [PMID: 38900438 PMCID: PMC11190831 DOI: 10.1001/jamaophthalmol.2024.1716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/07/2024] [Indexed: 06/21/2024]
Abstract
Importance Although the effectiveness of intracameral antibiotics to prevent postoperative endophthalmitis is described, selective use of antibiotics combined with 1% povidone iodine disinfection might be equally effective and could lead to cost reduction and avoidance of unnecessary use of antibiotics. Objective To compare the incidence of postoperative endophthalmitis when 1% povidone iodine disinfection is applied in combination with selective intracameral antibiotics with the incidence after routine use of intracameral antibiotics in combination with 5% povidone iodine. Design, Setting, and Participant This was a retrospective cohort study using incidence data from the ongoing endophthalmitis register of the Rotterdam Eye Hospital, a specialized hospital providing both secondary and tertiary ophthalmological care, when intracameral antibiotics were used only during cataract procedures with occurrence of a posterior capsular tear in comparison with results from cohorts described in the literature where routine antibiotics were used. All patients who had cataract (phacoemulsification) surgery at the Rotterdam Eye Hospital between 1993 and 2022 were included. No cataract surgical procedures combined with other intraocular procedures were included. Exposure Povidone iodine disinfection and intracameral antibiotics during cataract surgery either routinely or only in case of posterior capsular tears. Main Outcome and Measure Postoperative endophthalmitis incidence. Results Postoperative endophthalmitis incidence after 56 598 cataract (phacoemulsification) surgical procedures in the Rotterdam Eye Hospital between 2016 and 2022 was 0.000 (95% CI, 0.000-0.000). A PubMed literature search until September 2023 with respect to the incidence of postoperative endophthalmitis after routine antibiotic prophylaxis yielded 37 publications with an overall postoperative endophthalmitis incidence of 0.000 (95% CI, 0.000-0.000). Conclusions and Relevance No difference was observed between the postoperative endophthalmitis incidence during the last 7 years in the Rotterdam Eye Hospital and the overall postoperative endophthalmitis incidence after routine intracameral antibiotics prophylaxis as described in the literature. Disinfection with 1% povidone iodine in combination with selective antibiotic prophylaxis may be equally effective as routine antibiotic use and 5% povidone iodine.
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Affiliation(s)
| | - Karina Nolte
- Rotterdam Eye Hospital, Rotterdam, the Netherlands
| | | | - Sybren Lekkerkerk
- Department of Medical Microbiology, Maasstad General Hospital, Rotterdam, the Netherlands
| | | | - René Wubbels
- Rotterdam Ophthalmic Institute, Rotterdam, the Netherlands
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Kato A, Horita N, Namkoong H, Nomura E, Masuhara N, Kaneko T, Mizuki N, Takeuchi M. Prophylactic antibiotics for postcataract surgery endophthalmitis: a systematic review and network meta-analysis of 6.8 million eyes. Sci Rep 2022; 12:17416. [PMID: 36258003 PMCID: PMC9579149 DOI: 10.1038/s41598-022-21423-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/27/2022] [Indexed: 01/12/2023] Open
Abstract
To reveal optimal antibiotic prophylactic regimen for postoperative endophthalmitis (POE), we conducted systematic review and network meta-analysis. A total of 51 eligible original articles, including two randomized controlled trials, were identified. In total, 4502 POE cases occurred in 6,809,732 eyes (0.066%). Intracameral injection of vancomycin had the best preventive effect (odds ratio [OR] 0.03, 99.6% confidence interval [CI] 0.00-0.53, corrected P-value = 0.006, P-score = 0.945) followed by intracameral injection of cefazoline (OR 0.09, 99.6% CI 0.02-0.42, corrected P-value < 0.001, P-score = 0.821), cefuroxime (OR 0.18, 99.6% CI 0.09-0.35, corrected P-value < 0.001, P-score = 0.660), and moxifloxacin (OR 0.36, 99.6% CI 0.16-0.79, corrected P-value = 0.003, P-score = 0.455). While one randomized controlled trial supported each of intracameral cefuroxime and moxifloxacin, no randomized controlled trial evaluated vancomycin and cefazoline. Sensitivity analysis focusing on the administration route revealed that only intracameral injection (OR 0.19, 99.4% CI 0.12-0.30, corrected P-value < 0.001, P-score = 0.726) significantly decreased the risk of postoperative endophthalmitis. In conclusion, intracameral injection of either vancomycin, cefazoline, cefuroxime, or moxifloxacin prevented POE.
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Affiliation(s)
- Ai Kato
- grid.268441.d0000 0001 1033 6139Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 Japan ,Department of Ophthalmology, Chigasaki Municipal Hospital, Chigasaki, Kanagawa Japan
| | - Nobuyuki Horita
- grid.470126.60000 0004 1767 0473Chemotherapy Center, Yokohama City University Hospital, Yokohama, Kanagawa Japan
| | - Ho Namkoong
- grid.26091.3c0000 0004 1936 9959Department of Infectious Diseases, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Eiichi Nomura
- grid.268441.d0000 0001 1033 6139Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 Japan
| | - Nami Masuhara
- Department of Ophthalmology, Chigasaki Municipal Hospital, Chigasaki, Kanagawa Japan
| | - Takeshi Kaneko
- grid.268441.d0000 0001 1033 6139Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa Japan
| | - Nobuhisa Mizuki
- grid.268441.d0000 0001 1033 6139Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 Japan
| | - Masaki Takeuchi
- grid.268441.d0000 0001 1033 6139Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 Japan
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Lee K, Lee G, Lee S, Park CY. Advances in ophthalmic drug delivery technology for postoperative management after cataract surgery. Expert Opin Drug Deliv 2022; 19:945-964. [PMID: 35917497 DOI: 10.1080/17425247.2022.2109624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Cataract surgery is becoming more common due to an aging world population. Intraocular lenses and surgical technique have developed remarkably recently, but the development of postoperative medication to prevent postsurgery complications has been relatively delayed. We still largely depend on eye drops for the management of post-cataract-surgery patients. Mental and physical problems that often occur in elderly cataract patients make it difficult for patients to apply eye drops by themselves. It is necessary to develop new effective drug delivery methods. AREAS COVERED This updated review article provides a brief review of why drug management is needed following cataract surgery and an overview of current developments in new drug delivery methods for ophthalmic treatment. In particular, various novel drug delivery methods that can be used for post-cataract-surgery management and their current development stages are extensively reviewed. EXPERT OPINION Rapidly developing technologies, such as intraocular and external ophthalmic implants, polymers, and nanotechnology, are being actively applied to develop novel drug delivery systems for safe and effective management after cataract surgery. Their goal is to achieve sufficient drug release for the desired duration with a single application. These will largely replace the inconvenience of eye drops for elderly patients in the future.
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Affiliation(s)
- Kangmin Lee
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, Goyang, South Korea
| | - Gahye Lee
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, Goyang, South Korea
| | - Soomin Lee
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, Goyang, South Korea
| | - Choul Yong Park
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, Goyang, South Korea
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Design of Topical Moxifloxacin Mucoadhesive Nanoemulsion for the Management of Ocular Bacterial Infections. Pharmaceutics 2022; 14:pharmaceutics14061246. [PMID: 35745818 PMCID: PMC9228176 DOI: 10.3390/pharmaceutics14061246] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 02/04/2023] Open
Abstract
Ocular bacterial infections can lead to serious visual disability without proper treatment. Moxifloxacin (MOX) has been approved by the US Food and Drug Administration as a monotherapy for ocular bacterial infections and is available commercially as an ophthalmic solution (0.5% w/v). However, precorneal retention, drainage, and low bioavailability remain the foremost challenges associated with current commercial eyedrops. With this study, we aimed to design a MOX-loaded nanoemulsion (NE; MOX-NE) with mucoadhesive agents (MOX-NEM) to sustain MOX release, as well as to overcome the potential drawbacks of the current commercial ophthalmic formulation. MOX-NE and MOX-NEM formulations were prepared by hot homogenization coupled with probe sonication technique and subsequently characterized. The lead formulations were further evaluated for in vitro release, ex vivo transcorneal permeation, sterilization, and antimicrobial efficacy studies. Commercial MOX ophthalmic solution was used as a control. The lead formulations showed the desired physicochemical properties and viscosity. All lead formulations showed sustained release profiles a period of more than 12 h. Filtered and autoclaved lead formulations were stable for one month (the last time point tested) under refrigeration and at room temperature. Ex vivo transcorneal permeation studies revealed a 2.1-fold improvement in MOX permeation of the lead MOX-NE formulation compared with Vigamox® eyedrops. However, MOX-NEM formulations showed similar flux and permeability coefficients to those of Vigamox® eyedrops. The lead formulations showed similar in vitro antibacterial activity as the commercial eyedrops and crude drug solution. Therefore, MOX-NE and MOX-NEM formulations could serve as effective delivery vehicles for MOX and could improve treatment outcomes in different ocular bacterial infections.
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Marando CM, Neeson C, Solá-Del Valle D. Intracameral Antibiotics and Glaucoma Surgery. Int Ophthalmol Clin 2022; 62:125-143. [PMID: 35325915 DOI: 10.1097/iio.0000000000000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bhatta S, Pant N, Poudel M. Postoperative endophthalmitis with and without intracameral moxifloxacin prophylaxis in a high volume surgery setting. BMJ Open Ophthalmol 2021; 6:e000609. [PMID: 34179508 PMCID: PMC8186757 DOI: 10.1136/bmjophth-2020-000609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 05/21/2021] [Indexed: 11/19/2022] Open
Abstract
Objective This study was conducted to understand the effects of intracameral moxifloxacin in decreasing the incidence of postoperative endophthalmitis after cataract surgery in an eye hospital with a high volume surgical load. Methods and analysis In this single-centre, retrospective, clinical registry-based study, we compared the rates of postoperative endophthalmitis in 31 340 cataract surgery patients operated during 22 months after June 2018 who received intracameral moxifloxacin to 80 643 patients operated during 41 months before June 2018 who did not receive intracameral moxifloxacin. All patients received subconjunctival gentamycin and dexamethasone. Combined surgical procedures were excluded from the study. Results There was a significant reduction (p<0.001) of postoperative endophthalmitis rates in cataract surgeries from 0.144% (116/80 643) to 0.025% (8/31 340) after initiation of intracameral moxifloxacin. Endophthalmitis rates decreased from 0.120% (12/9942) to 0.009% (1/10 787) in phacoemulsification group and from 0.147% (104/70 701) to 0.034% (7/20 553) in manual small-incision cataract surgeries. Gram-positive organisms including Coagulase-negative staphylococci (37.9%, n=11) and Staphylococcus aureus (S. aureus 34.5%, n=10) were the most common organisms isolated out of 29 culture-positive cases. 24.1% (28/116) endophthalmitis cases in group without moxifloxacin were culture positive compared with 14.3% (1/7) of cases in moxifloxacin group. 72% (n=8) of the Coagulase-negative staphylococci and 80% of S. aureus isolates (n=8) showed in vitro sensitivity to moxifloxacin. Conclusion Prophylactic use of intracameral moxifloxacin injection in addition to subconjunctival gentamycin in cataract surgery is associated with a significant decrease in rates of postoperative endophthalmitis when compared with the use of subconjunctival gentamycin alone in high volume settings.
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Affiliation(s)
| | | | - Manish Poudel
- Statistics, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
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Kato JM, Tanaka T, de Oliveira LMS, de Oliveira MS, Rossi F, Goldbaum M, Pimentel SLG, de Almeida Junior JN, Yamamoto JH. Surveillance of post-cataract endophthalmitis at a tertiary referral center: a 10-year critical evaluation. Int J Retina Vitreous 2021; 7:14. [PMID: 33593443 PMCID: PMC7885210 DOI: 10.1186/s40942-021-00280-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 02/08/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Acute post-cataract endophthalmitis (APE) is a rare complication potentially causing irreversible visual loss. A 10-year study of APE was conducted to determine its incidence, microbiological spectra and antibiotic resistance profile of APE-related pathogens at a major tertiary referral center in Brazil. METHODS APE cases reported between January 2010 and December 2019 were included. Phacoemulsification and extracapsular cataract techniques were eligible; combined procedures, traumatic and congenital cataract were excluded. Vitreous samples were cultured and antimicrobial resistance was compared for the periods of 2010-2014 and 2015-2019. The results were analyzed with Fisher's exact test. RESULTS Our sample consisted of 40,491 cataract surgeries and 51 (0.126%) APE cases. Culture was positive in 35 cases (71.4%), of which 31 (88.6%) Gram-positive, 3 (8.6%) Gram-negative, and 1 (2.9%) fungal. The most frequently isolated organism was Staphylococcus epidermidis (n = 17/35, 48.6%), followed by Staphylococcus aureus (n = 4/35, 11.4%). From 2010-2014 to 2015-2019, antimicrobial resistance increased against moxifloxacin (11.1-54.5%, p = 0.07), ciprofloxacin (54.5-72.7%, p = 0.659) and oxacillin (66.7-93.3%, p = 0.13). CONCLUSIONS The observed incidence and microbial spectra were compatible with previous studies. A trend towards growing moxifloxacin and ciprofloxacin resistance was observed. Surveillance remains crucial to prevent treatment failure from antimicrobial resistance.
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Affiliation(s)
- Juliana Mika Kato
- Department of Ophthalmology-LIM33, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, 255 Av. Dr. Enéas Carvalho de Aguiar, São Paulo, Brazil.
| | - Tatiana Tanaka
- Department of Ophthalmology-LIM33, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, 255 Av. Dr. Enéas Carvalho de Aguiar, São Paulo, Brazil
| | - Luiza Manhezi Shin de Oliveira
- Department of Ophthalmology-LIM33, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, 255 Av. Dr. Enéas Carvalho de Aguiar, São Paulo, Brazil
| | - Maura Salaroli de Oliveira
- Division of Infectious and Parasitic Diseases, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Flavia Rossi
- Central Laboratory Division-LIM03, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mauro Goldbaum
- Department of Ophthalmology-LIM33, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, 255 Av. Dr. Enéas Carvalho de Aguiar, São Paulo, Brazil
| | - Sergio Luis Gianotti Pimentel
- Department of Ophthalmology-LIM33, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, 255 Av. Dr. Enéas Carvalho de Aguiar, São Paulo, Brazil
| | - João Nóbrega de Almeida Junior
- Central Laboratory Division-LIM03, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Institute of Tropical Medicine-LIM53, University of São Paulo (USP), São Paulo, Brazil
| | - Joyce Hisae Yamamoto
- Department of Ophthalmology-LIM33, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, 255 Av. Dr. Enéas Carvalho de Aguiar, São Paulo, Brazil
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The Anterior Chamber Injection of Moxifloxacin Injection to Prevent Endophthalmitis after Cataract Surgery: A Meta-analysis. J Ophthalmol 2020; 2020:7242969. [PMID: 32908685 PMCID: PMC7468651 DOI: 10.1155/2020/7242969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/17/2020] [Accepted: 06/19/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose A meta-analysis was performed to compare the efficacy of an anterior chamber injection of moxifloxacin in the prevention of endophthalmitis after cataract surgery. Methods A computer-based search of PubMed, Embase, the Cochrane Library, and the Clinical Trial database for articles related to anterior intraventricular injection of moxifloxacin for the prevention of endophthalmitis after cataract surgery was performed through April 2019. Study selection, data exclusion, and quality assessment were performed by two independent observers. Statistical analysis for the meta-analysis was performed by RevMan5.3 software. Results Eight studies were included, with a total of 123,819 eyes. The meta-analysis showed that an anterior chamber injection of moxifloxacin can prevent the incidence of endophthalmitis after cataract surgery (OR = 0.29, 95% CI (0.15, 0.56), P=0.0002), and the difference was statistically significant. There were no significant differences between the moxifloxacin injection and nonmoxifloxacin injection groups in regard to UCVA (log MAR) (SMD = −0.13, 95% CI (−0.62, 0.35), P=0.60), BCVA (log MAR) (SMD = −0.27, 95% CI (−1.28, 0.74), P=0.60), IOP (SMD = −0.04, 95% CI (−0.02, 0.01), P=0.22), corneal edema (OR = 1.03, 95% CI (0.23, 4.69), P=0.97), CCT (SMD = −0.01, 95% CI (−0.07, 0.05), P=0.77), or ECD (SMD = 0.00, 95% CI (−0.06, 0.07), P=0.94). Conclusion An anterior chamber injection of moxifloxacin can effectively prevent the incidence of endophthalmitis after cataract surgery, while the moxifloxacin injection and nonmoxifloxacin injection groups had similar results in regard to UCVA (log MAR), BCVA (log MAR), IOP, corneal edema, CCT, and ECD.
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An Alternative Approach to Cataract Surgery Using BSS Temperature of 2.7 °C. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10082682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The aim of this study is to evaluate the difference in the number of endothelial cells after cataract operations with phacoemulsification by using a balanced salt solution (BSS) at standard temperature (about 20 °C) and at 2.7 °C. Two groups, comprising 214 individuals in total, participated in this study; patients were operated on using BSS bottle at about 20 °C and 2.7 °C in the first and second groups, respectively. All operations were conducted by the same surgeon and in similar conditions. One month after the operations, endothelial cells in the two groups were checked. For patients in Group 2, an important reduction in the loss of endothelial cells was observed.
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Kishore K, Brown JA, Satar JM, Hahn JM, Bond WI. Acute-onset postoperative endophthalmitis after cataract surgery and transzonular intravitreal triamcinolone–moxifloxacin. J Cataract Refract Surg 2018; 44:1436-1440. [DOI: 10.1016/j.jcrs.2018.07.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
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