Aravind Eye Hospital, Madurai, India.
Altos Eye Physicians, Los Altos, California.
Ophthalmology. 2016 Feb;123(2):302-308. doi: 10.1016/j.ophtha.2015.09.037. Epub 2015 Oct 30.
To compare the rate of postoperative endophthalmitis before and after initiation of intracameral (IC) moxifloxacin for endophthalmitis prophylaxis in patients undergoing cataract surgery.
Retrospective, clinical registry.
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.
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.
Postoperative endophthalmitis rate before and after initiation of IC moxifloxacin endophthalmitis treatment cost.
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.
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.
比较白内障手术后患者行前房内（IC）莫西沙星预防眼内炎前后眼内炎的发生率。
回顾性临床登记。
2014 年 2 月 15 日至 2015 年 4 月 15 日期间在马杜赖阿拉文眼科医院接受白内障手术的所有慈善和私人患者（116714 只眼）均被纳入研究。第 1 组包括 37777 只接受慈善手术但未接受 IC 莫西沙星的眼，第 2 组包括 38160 只接受 IC 莫西沙星预防用药的慈善手术眼，第 3 组包括 40777 只未接受 IC 莫西沙星的私人手术眼。
分析每组的电子健康记录数据，并对术后眼内炎发生率进行统计学比较。计算眼内炎治疗（第 1 组和第 2 组）的费用和 IC 莫西沙星预防用药（第 2 组）的费用。
IC 莫西沙星预防用药前后眼内炎发生率、眼内炎治疗费用。
慈善人群（97%）中，手工、无缝线、小切口白内障手术（M-SICS）约占所有 75937 例白内障手术的全部，而私人人群（21%M-SICS；79%超声乳化术）中仅占少数。第 1 组 30 只眼（0.08%）和第 2 组 6 只眼（0.02%）诊断为术后眼内炎（P<0.0001）。第 3 组的眼内炎发生率为 0.07%（29 只眼），也高于第 2 组（P<0.0001）。第 2 组无与 IC 莫西沙星相关的不良事件。第 1 组 30 例眼内炎患者的治疗总费用与第 2 组 6 例眼内炎常规 IC 莫西沙星预防用药和治疗总费用几乎相同。
M-SICS 患者常规 IC 莫西沙星预防可显著降低术后眼内炎的发生率，降低 4 倍。与以往的研究相比，在相对较短的 14 个月时间内有如此大量的患者接受手术，进一步加强了这一结论。本研究进一步证实莫西沙星是一种有效的 IC 预防性抗生素，并提示对于 M-SICS 和超声乳化术，应考虑使用 IC 抗生素。
