title: Efficacy of Intracameral Moxifloxacin Endophthalmitis Prophylaxis at Aravind Eye Hospital.
abstract: OBJECTIVE
  To compare the rate of postoperative endophthalmitis before and after initiation of intracameral (IC) moxifloxacin for endophthalmitis prophylaxis in patients undergoing cataract surgery.
  
  
  METHODS
  Retrospective, clinical registry.
  
  
  METHODS
  All charity and private patients (116 714 eyes) who underwent cataract surgery between February 15, 2014, and April 15, 2015, at the Madurai Aravind Eye Hospital were included. Group 1 consisted of 37 777 eyes of charity patients who did not receive IC moxifloxacin, group 2 consisted of 38 160 eyes of charity patients who received IC moxifloxacin prophylaxis, and group 3 consisted of 40 777 eyes of private patients who did not receive IC moxifloxacin.
  
  
  METHODS
  The electronic health record data for each of the 3 groups were analyzed, and the postoperative endophthalmitis rates were statistically compared. The cost of endophthalmitis treatment (groups 1 and 2) and the cost of IC moxifloxacin prophylaxis (group 2) were calculated.
  
  
  METHODS
  Postoperative endophthalmitis rate before and after initiation of IC moxifloxacin endophthalmitis treatment cost.
  
  
  RESULTS
  Manual, sutureless, small incision cataract surgery (M-SICS) accounted for approximately all of the 75 937 cataract surgeries in the charity population (97%), but only a minority of the 40 777 private surgeries (21% M-SICS; 79% phacoemulsification). Thirty eyes in group 1 (0.08%) and 6 eyes in group 2 (0.02%) were diagnosed with postoperative endophthalmitis (P < 0.0001). The group 3 endophthalmitis rate was 0.07% (29 eyes), which was also higher than the second group's rate (P < 0.0001). There were no adverse events attributed to IC moxifloxacin in group 2. The total cost of treating the 30 patients with endophthalmitis in group 1 was virtually identical to the total combined cost in group 2 of routine IC moxifloxacin prophylaxis and treatment of the 6 endophthalmitis cases.
  
  
  CONCLUSIONS
  Routine IC moxifloxacin prophylaxis achieved a highly significant, 4-fold reduction in postoperative endophthalmitis in patients undergoing M-SICS. Compared with previous studies, having such a high volume of patients undergoing surgery during a relatively short 14-month time period strengthens the conclusion. This study provides further evidence that moxifloxacin is an effective IC prophylactic antibiotic and suggests that IC antibiotics should be considered for M-SICS and phacoemulsification.
authors.affiliation: Aravind Eye Hospital, Madurai, India. Electronic address: haripriya@aravind.org.
authors.forename: Aravind
authors.initials: A
authors.lastname: Haripriya
authors.affiliation: Altos Eye Physicians, Los Altos, California.
authors.forename: David F
authors.initials: DF
authors.lastname: Chang
authors.affiliation: John Hopkins University, Baltimore, Maryland.
authors.forename: Sathvik
authors.initials: S
authors.lastname: Namburar
authors.affiliation: Aravind Eye Hospital, Madurai, India.
authors.forename: Anand
authors.initials: A
authors.lastname: Smita
authors.affiliation: Aravind Eye Hospital, Madurai, India.
authors.forename: Ravilla D
authors.initials: RD
authors.lastname: Ravindran
mesh_terms: D000368:Aged; D000867:Anterior Chamber / Q000187:drug effects*; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002387:Cataract Extraction; D002608:Charities; D016527:Drug Costs; D057286:Electronic Health Records / Q000706:statistics & numerical data; D009877:Endophthalmitis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D015818:Eye Infections, Bacterial / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D024841:Fluoroquinolones / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D016304:Hospitals, Private; D006779:Hospitals, Public; D006782:Hospitals, Special; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D009885:Ophthalmology; D011183:Postoperative Complications; D012042:Registries; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D000077266:Moxifloxacin