The intracameral cefuroxime/moxifloxacin debate

September 6, 2010

A report from the Endophthalmitis symposia at ESCRS

Per Montan introduced delegates to his own unique critical look at the peer-reviewed journals which have covered the cefuroxime/moxifloxacin debate.

Whilst acknowledging that he had had five articles published himself which looked at the topic of cefuroxime, he wished to declare his neutrality on the subject as he was not a strong advocator of either.

Cefuroximne was introduced in the 70s and its mode of action is to target the cell walls. Moxifloxacin is the new contender on the block, having been around for just a decade.

The use of intracameral cefuroxime at the end of cataract surgery reduces the occurrence of postoperative endophthalmitis, according to the findings of a multicentre study carried out by the European Society of Cataract and Refractive Surgeons (ESCRS).These findings were published in the June issue of the Journal of Cataract & Refractive Surgery, following on from their first presentation at the 2006 ESCRS congress in London, UK.

The prospective, randomized, partially masked multicentre study enrolled 16,603 patients from 24 ophthalmology units in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey and the United Kingdom. The study was based on a 2×2 factorial design, with intracameral cefuroxime and topical perioperative levofloxacin factors resulting in four treatment groups.

A total of 29 patients presented with endophthalmitis, of whom 20 were classified as having proven infective endophthalmitis. The absence of an intracameral cefuroxime prophylactic regimen at 1 mg in 0.1 mL normal saline was associated with a 4.92-fold increase in the risk for total postoperative endophthalmitis. Furthermore, the use of clear corneal incisions, compared with scleral tunnels, was associated with a 5.88-fold increase in risk in infection, whilst the use of silicone intraocular lens (IOL) material compared with acrylic was associated with a 3.13-fold increased risk.

It was concluded that intracameral cefuroxime use can reduce the risk of developing postoperative endophthalmitis and that other risk factors include clear corneal incisions and the use of silicone IOLs.

“Alas, there is no data yet reported in any peer reviewed journal about moxifloxacin. I would therefore urge those of you out there who are using it to send in your data to the journals so we can learn more.”

A fuller report on Per Montan's critique will appear at a later date.