Prophylactic intracameral levofloxacin in cataract surgery - an evaluation of safety

Cesar Ramon G Espiritu, Joanne G Bolinao, Cesar Ramon G Espiritu, Joanne G Bolinao

Abstract

Purpose: To evaluate posterior and anterior segment safety of an intracameral injection of levofloxacin 0.5% ophthalmic solution as prophylaxis for patients undergoing cataract extraction and intraocular lens implantation.

Setting: This study was conducted at Manila Doctors Hospital, Ermita, Manila, Philippines.

Design: This was a prospective interventional study.

Methods: Eyes undergoing standard phacoemulsification cataract surgery with intraocular lens implantation were treated with intracameral levofloxacin 0.5% at the conclusion of surgery. Safety parameters, including best-corrected visual acuity (BCVA), endothelial cell counts, anterior chamber cells and flare, and central foveal thickness, were evaluated preoperatively and at 1 day and 1 week postoperatively.

Results: A total of 50 eyes of 50 patients were included in the analysis. At 1 week postoperatively, all eyes demonstrated BCVA of 20/30 or better and 19 eyes (38%) achieved BCVA of 20/20 or better. On the first postoperative day, no corneal edema was observed, and trace to +2 cells and flare in the anterior chamber were noted in all eyes. After 1 week, all eyes had a quiet anterior chamber and endothelial cell counts decreased by an average of 225 cells/mm2, which was marginally significant (p=0.0525) when compared to other time points. Optical coherence tomography results showed no statistically significant differences between central foveal thickness measurements before and after surgery. There were also no statistically significant differences in preoperative and postoperative pachymetry. No study-related adverse events occurred.

Conclusion: There were no safety concerns associated with intracameral injection of levofloxacin 0.5%, prophylactically, following cataract surgery. Further study is required to demonstrate effectiveness in endophthalmitis prevention.

Keywords: cataract surgery; endophthalmitis prevention; intracameral levofloxacin; intraocular surgery; phacoemulsification; prophylaxis.

Conflict of interest statement

Disclosure The authors have no proprietary interest in the materials used in this study and report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Postoperative visual acuity of patient population (BCVA). Abbreviation: BCVA, best-corrected visual acuity.
Figure 2
Figure 2
Anterior chamber reaction: postoperative endothelial cell count (cells/mm2), illustrating the presence of corneal edema.
Figure 3
Figure 3
Comparison of mean endothelial cell count (cells/mm2; preoperative vs postoperative).
Figure 4
Figure 4
Comparison of mean pachymetry (μm; preoperative vs postoperative).
Figure 5
Figure 5
Comparison of mean central foveal thickness measurements (μm; preoperative vs postoperative).

References

    1. Chang DF, Braga-Mele R, Mamalis N, et al. ASCRS cataract clinical committee. J Cataract Refract Surg. 2007;33(10):1801–1805.
    1. Barry P, Seal DV, Gettinby G, Lees F, Peterson M, Revie CW, ESCRS Endophthalmitis Study Group ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: preliminary report of principal results from a European multicenter study. J Cataract Refract Surg. 2006;32(3):407–410.
    1. Haripriya A, Chang DF, Namburar S, Smita A, Ravindran RD. Efficacy of intracameral moxifloxacin endophthalmitis prophylaxis at Aravind Eye Hospital. Ophthalmology. 2016;123(2):302–308.
    1. Gower EW, Lindsley K, Tulenko SE, Nanji AA, Leyngold I, McDonnell PJ. Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery. Cochrane Database Syst Rev. 2017;2:CD006364.
    1. Espiritu CR, Caparas VL, Bolinao JG. Safety of prophylactic intracameral moxifloxacin 0.5% ophthalmic solution in cataract surgery patients. J Cataract Refract Surg. 2007;33(1):63–68.
    1. Chang DF, Braga-Mele R, Henderson BA, et al. ASCRS Cataract Clinical Committee Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery: results of the 2014 ASCRS member survey. J Cataract Refract Surg. 2015;41(6):1300–1305.
    1. Delyfer MN, Rougier MB, Leoni S, et al. Ocular toxicity after intracameral injection of very high doses of cefuroxime during cataract surgery. J Cataract Refract Surg. 2011;37(2):271–278.
    1. Olavi P. Ocular toxicity in cataract surgery because of inaccurate preparation and erroneous use of 50mg/ml intracameral cefuroxime. Acta Ophthalmol. 2012;90(2):e153–e154.
    1. Kim SY, Park YH, Lee YC. Comparison of the effect of intracameral moxifloxacin, levofloxacin and cefazolin on rabbit corneal endothelial cells. Clin Exp Ophthalmol. 2008;36(4):367–370.
    1. Gore DM, Angunawela RI, Little BC. United Kingdom survey of antibiotic prophylaxis practice after publication of the ESCRS Endophthalmitis Study. J Cataract Refract Surg. 2009;35(4):770–773.
    1. Creuzot-Garcher C, Benzenine E, Mariet AS, et al. Incidence of acute postoperative endophthalmitis after cataract surgery: a nationwide study in France from 2005 to 2014. Ophthalmology. 2016;123(7):1414–1420.
    1. Packer M, Chang DF, Dewey SH, et al. ASCRS Cataract Clinical Committee Prevention, diagnosis, and management of acute postoperative bacterial endophthalmitis. J Cataract Refract Surg. 2011;37(9):1699–1714.
    1. Friling E, Lundstrom M, Stenevi U, Montan P. Six-year incidence of endophthalmitis after cataract surgery: Swedish national study. J Cataract Refract Surg. 2013;39(1):15–21.
    1. Beselga D, Campos A, Castro M, et al. Postcataract surgery endophthalmitis after introduction of the ESCRS protocol: a 5-year study. Eur J Ophthalmol. 2014;24(4):516–519.
    1. Shorstein NH, Winthrop KL, Herrinton LJ. Decreased postoperative endophthalmitis rate after institution of intracameral antibiotics in a Northern California eye department. J Cataract Refract Surg. 2013;39(1):8–14.
    1. Schimel AM, Miller D, Flynn HW., Jr Endophthalmitis isolates and antibiotic susceptibilities: a 10-year review of culture-proven cases. Am J Ophthalmol. 2013;156(1):50–52.
    1. Tan CS, Wong HK, Yang FP. Epidemiology of postoperative endophthalmitis in an Asian population: 11-year incidence and effect of intracameral antibiotic agents. J Cataract Refract Surg. 2012;38(3):425–430.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa