Endophthalmitis after uncomplicated cataract surgery with the use of fourth-generation fluoroquinolones: a retrospective observational case series.
OBJECTIVE
To estimate the rate of acute postoperative endophthalmitis after uncomplicated cataract surgery in patients treated before and after surgery with 1 of 2 different fourth-generation fluoroquinolone ophthalmic drops for surgical prophylaxis.


METHODS
Retrospective, multicenter, observational case series.


METHODS
Included in this study were 20,013 patients from 9 cataract surgery centers in 7 states in the United States.


METHODS
Patients who had undergone uncomplicated phacoemulsification who received preoperative and postoperative topical fourth-generation fluoroquinolones for surgical prophylaxis between March 2003 and July 2005 were included in the study. The files of patients in whom acute endophthalmitis developed were reviewed and analyzed.


METHODS
Number and rate of endophthalmitis cases after uncomplicated cataract surgery.


RESULTS
During the study period, the participating surgeons performed 20,013 uncomplicated surgeries. Of these, 16,209 patients (81%) received topical gatifloxacin and 3804 patients (19%) were treated with topical moxifloxacin as antiinfective prophylaxis. A total of 14 patients experienced endophthalmitis. The overall rate of endophthalmitis was 0.07%. There were 9 endophthalmitis patients in the gatifloxacin group and 5 endophthalmitis patients in the moxifloxacin group. The rate of endophthalmitis in the gatifloxacin group was 0.06% and the rate in the moxifloxacin group was 0.1%. The difference in the rate of endophthalmitis between the 2 groups was not statistically significant. In 10 of the patients, vitreous culture results were positive. Coagulase-negative staphylococci, followed by streptococci, species were the most commonly isolated organisms in the culture-positive patients.


CONCLUSIONS
The overall rate of endophthalmitis after uncomplicated cataract surgery in patients treated with topical fourth-generation fluoroquinolones as antiinfective prophylaxis was 0.07%. This rate was within the range of previously reported rates of endophthalmitis in the literature. The difference in the observed rate of postoperative endophthalmitis in patients treated with moxifloxacin versus gatifloxacin was not statistically significant.
Moshirfar
Majid
M
John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
Feiz
Vahid
V
Vitale
Albert T
AT
Wegelin
Jacob A
JA
Basavanthappa
Screenivasa
S
Wolsey
Darcey H
DH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001372:Aza Compounds / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D009877:Endophthalmitis / Q000382:microbiology* / Q000517:prevention & control; D015818:Eye Infections, Bacterial / Q000382:microbiology* / Q000517:prevention & control; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D000077734:Gatifloxacin; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D009883:Ophthalmic Solutions / Q000627:therapeutic use; D018918:Phacoemulsification; D011183:Postoperative Complications; D011804:Quinolines / Q000627:therapeutic use; D012189:Retrospective Studies; D014822:Vitreous Body / Q000382:microbiology
D000890:Anti-Infective Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D009883:Ophthalmic Solutions; D011804:Quinolines; D000077734:Gatifloxacin; D000077266:Moxifloxacin