Effectiveness of Topical Moxifloxacin Before Cataract Surgery in Reducing Corneal Surface Flora
For many years, topical antibiotics have been administered perioperatively in cataract surgery to prevent endophthalmitis....
Effectiveness of Topical Moxifloxacin Before Cataract Surgery in Reducing Corneal Surface Flora: Doubts and Key Points
Dr. Caroline Wilson, Ophthalmology Resident, University of Iowa
For many years, topical antibiotics have been administered perioperatively in cataract surgery to prevent endophthalmitis. With the increasing popularity of intracameral antibiotics, questions have been raised regarding the necessity of continuing topical antibiotic use before and after cataract procedures.
Dr. Wilson noted:
“Several studies have shown comparable effectiveness between topical and intracameral antibiotics in preventing endophthalmitis. In addition, some research indicates that using topical antibiotics (pre- and/or postoperatively) offers no proven benefit over antiseptic solutions and intracameral antibiotics for endophthalmitis prevention.”
Moreover, increasing the frequency and duration of topical antibiotic administration does not further reduce conjunctival surface flora. There are also concerns about the development of antibiotic resistance, both in the general population and in individual patients. The European Society of Cataract and Refractive Surgeons has even recommended against the use of preoperative topical antibiotics.
New Study and Results
In a study conducted by Dr. Wilson’s team, one group of patients instilled topical moxifloxacin four times daily for three days prior to cataract surgery, while the control group received no antibiotics. Conjunctival swabs were collected before and on the day of surgery (prior to antiseptic application) for culture, identification, and antibiotic resistance testing.
Findings:
Coagulase-negative staphylococci (CoNS) were the most frequently isolated bacteria in both groups. Among patients who used moxifloxacin, 52% still had bacterial growth on the ocular surface on the day of surgery (versus 100% in the control group). Notably, 17.6% of the treated patients had bacteria resistant to moxifloxacin after only three days of use.
Conclusion
“Topical moxifloxacin administered before cataract surgery does not effectively reduce ocular surface flora in most patients, and antimicrobial resistance can develop within as little as three days of use.”
Dr. Wilson suggested that future research should also examine whether preoperative topical antibiotics influence the efficacy of intracameral antibiotics against ocular bacteria.
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