shown to be superior in a prospective, randomized, placebo-con-
trolled clinical trial. But evidence in favor of intracameral has mount-
ed to the point where around 50% (and counting) of U.S. surgeons
consider it the best option. Most notably, a prospective study from the
European Society of Cataract & Refractive Surgeons (ESCRS) showed
a 5-fold decrease in endophthalmitis rate with intracameral antibiotic
compared with topical antibiotic. What's hindering wider adoption?
For now, experts say, the lack of an FDA-approved drug for intracam-
eral delivery and the resulting fears of toxic errors committed at com-
pounding pharmacies.
Surgeon preference
In this landscape, surgeons base their choice of antibiotic for intra-
cameral injection on known effectiveness against endophthalmitis-
causing pathogens and consideration of the breadth of what's been
reported about safety and efficacy for this use. They're most likely to
want to use moxifloxacin or cefuroxime. Vancomycin had also been a
common choice until it was associated with extremely rare yet visual-
ly devastating post-operative hemorrhagic occlusive retinal vasculitis
(HORV). When choosing an antibiotic, surgeons might also consider
your facility's infection profile.
• Moxifloxacin. A popular off-label choice for intracameral injection
is the commercially available, self-preserved formulation of moxi-
floxacin (Vigamox 0.5%, 3mL in a 4mL bottle). The simplest method:
9 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 1 8
If intracameral moxifloxacin is
shown to be superior, we'll seek
FDA approval of the formulation.
— Eric D. Donnenfeld, MD, FACS
