Do We Still Need To Use Antibiotic Eye Drops After Routine Catatract Surgery?

According to the clinical protocols of EU countries (despite the use povidone-iodine and intracameral cefuroxime) antibiotics in drops are used in 100% cases in the postoperative period.

Our aim - to evaluate the safey and efficacy of intracameral moxifloxacin in routine cataract surgery without the use of postoperative topical antibiotics.

LLC “Shevchyk Vasyl Eye Microsurgery,” Chernihiv, Ukraine.

600 patients with age-related cataract were randomized into two equial groups

1. Control group – topical levofloxacin for 7 days postoperatively.

2. Study group –  0.5 mL intracameral moxifloxacin (150 mg/0.1 mL; Arshinoff & Shi, JCRS 2023) at the end of surgery, without any postoperative topical antibiotics.

Postoperatively, both groups received topical corticosteroids and lubricants for 1 month.

Follow-up examinations were conducted on days 1, 7, 30, and 90.
The following parameters were assessed:

• Endothelial cell density and morphology (specular microscope SP-1P, Topcon)
• Postoperative inflammatory reaction
• Infectious complications
• Patient compliance with drop regimens

• Infectious safety: No cases of postoperative endophthalmitis were observed in either group.
• Inflammation: Three patients in the control group developed fibrinoid reaction, successfully managed with peribulbar dexamethasone injections.
• Endothelial safety: Endothelial cell loss was comparable between groups (3.8 ± 3.6% control vs 3.6 ± 3.3% study; p > 0.05), with no significant differences in hexagonality or polymegathism.
• No cases of toxic anterior segment syndrome (TASS) or corneal epitheliopathy occurred in either group.
• Compliance: Non-adherence to topical therapy occurred in 22% of the control group (missed doses, premature discontinuation, or prolonged use), while only 8% of the study group reported minor issues

Intracameral moxifloxacin is a safe and effective method of prophylaxis against infectious complications after phacoemulsification. It demonstrates comparable endothelial safety, reduces patient non-compliance, and represents a significant step towards fully drop-free cataract surgery.