O'Brien Terrence P, Arshinoff Steve A, Mah Francis S
Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, Florida 33418, USA.
J Cataract Refract Surg. 2007 Oct;33(10):1790-800. doi: 10.1016/j.jcrs.2007.06.026.
To aid the cataract surgeon's understanding of rational approaches to antimicrobial prophylaxis and place the European Society of Cataract & Refractive Surgeons (ESCRS) postoperative endophthalmitis study in perspective, a review was conducted of published and unpublished data on intracameral antibiotic use during cataract surgery and the antimicrobial efficacy, pharmacodynamics, ocular penetration, and safety of moxifloxacin. The ESCRS-sponsored study of postoperative endophthalmitis prophylaxis reported rates of presumed infectious postoperative endophthalmitis of 0.07% with intracameral cefuroxime treatment and 0.34% in control groups. Postoperative endophthalmitis after cefuroxime use was mostly due to cefuroxime-resistant gram-positive bacteria. Intracameral cefuroxime also requires extemporaneous compounding, has short-term stability, and carries a risk for hypersensitivity. Moxifloxacin, a fourth-generation fluoroquinolone, has potent and rapid bactericidal activity against the most common gram-positive postoperative endophthalmitis pathogens, has excellent ocular penetration after topical administration, and is available in a self-preserved ophthalmic formulation that has been shown safe and effective in preventing endophthalmitis when administered intracamerally in an animal model. Available data suggest that the optimum antibiotic regimen and route of delivery for cataract surgery antimicrobial prophylaxis require further study. Moxifloxacin offers many theoretical advantages that make it an attractive first-line choice for topical use and of interest for intracameral administration.
为帮助白内障手术医生理解抗菌药物预防的合理方法，并正确看待欧洲白内障与屈光手术医师学会（ESCRS）的术后眼内炎研究，我们对已发表和未发表的有关白内障手术中前房内使用抗生素的数据以及莫西沙星的抗菌效力、药效学、眼内渗透性和安全性进行了综述。ESCRS赞助的术后眼内炎预防研究报告称，前房内使用头孢呋辛治疗的假定感染性术后眼内炎发生率为0.07%，对照组为0.34%。使用头孢呋辛后的术后眼内炎主要由耐头孢呋辛的革兰氏阳性菌引起。前房内使用头孢呋辛还需要临时配制，稳定性差，且有过敏风险。莫西沙星是一种第四代氟喹诺酮类药物，对最常见的革兰氏阳性术后眼内炎病原体具有强大而快速的杀菌活性，局部给药后眼内渗透性极佳，并且有一种自保存的眼科制剂，在动物模型中前房内给药时已证明在预防眼内炎方面安全有效。现有数据表明，白内障手术抗菌药物预防的最佳抗生素方案和给药途径需要进一步研究。莫西沙星具有许多理论优势，使其成为局部使用的有吸引力的一线选择，也值得进行前房内给药研究。
