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Safety of Intracameral Injection of Moxifloxacin and Dexamethasone (Vigadexa®) After Phacoemulsification Surgery
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In this study, the authors investigated the degree of corneal endothelial cell loss (ECL) in patients treated with intracameral injection of a combination of 0.5% moxifloxacin and 0.1% dexamethasone (Vigadexa®) at the end of cataract surgery. The overall median ECL rate was 4.6% following surgery, and none of the patients developed toxic anterior segment syndrome. The rates of ECL noted with Vigadexa use were consistent with those reported in previous studies that evaluated the use of intracameral antibiotics (3.6%–18.3%). Regression analysis showed that a higher degree of ECL was associated with nuclear color grade and cumulative dissipated energy, confirming previous findings in other published studies.
- Intracameral injection of Vigadexa may not be associated with higher rates of ECL compared with the use of other intracameral antibiotics.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Intracameral antibiotics, such as moxifloxacin and cefuroxime, are safe to corneal endothelial cells and effective prophylaxis of endophthalmitis after cataract surgery. Corneal endothelial cells decrease in density after cataract surgery. Any substance used in the anterior chamber may affect corneal endothelial cells and lead to a greater decrease in density. This study wants to determine the percentage of endothelial cell loss after cataract extraction by phacoemulsification with off-label intracameral injection of moxifloxacin and dexamethasone (Vigadexa®).
METHODS
An observational retrospective study was performed. The clinical records of patients undergoing cataract surgery by phacoemulsification plus intracameral injection of Vigadexa® were analyzed. Endothelial cell loss (ECL) was calculated using preoperative and postoperative endothelial cell density. The relation of endothelial cell loss with cataract grade using LOCS III classification, total surgery time, total ultrasound time, total longitudinal power time, total torsional amplitude time, total aspiration time, estimated fluid usage, and cumulative dissipated energy (CDE) was studied using univariate linear regression analysis and logistic regression analysis.
RESULTS
The median loss of corneal endothelial cells was 4.6%, interquartile range 0 to 10.4%. Nuclear color and CDE were associated with increased ECL. ECL>10% was associated with age and total ultrasound time in seconds.
CONCLUSIONS
The endothelial cell loss after the intracameral use of Vigadexa® at the end of cataract surgery was similar to the reported in other studies of cataract surgery without the use of intracameral prophylaxis for postoperative endophthalmitis (POE). This study confirmed the association of CDE and nuclear opalescence grade with postoperative corneal endothelial cell loss.
Additional Info
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Safety of intracameral application of moxifloxacin and dexamethasone (Vigadexa®) after phacoemulsification surgery
Graefes Arch. Clin. Exp. Ophthalmol 2023 Nov 01;261(11)3215-3221, V Galvis, AM Prada, A Tello, MM Parra, PA Camacho, MP PolitFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The investigators performed a retrospective review of data from 159 eyes of 101 patients treated with cataract surgery and off-label intracameral injection of a preservative-free combination of moxifloxacin and dexamethasone (Vigadexa). At 3 months following surgery, the median rate of corneal endothelial cell loss was 4.6%, which was comparable to that reported in previously published case series, including those that investigated the use of intracameral antibiotics without corticosteroids.
The tested drug is commercially available in Colombia and other countries but not in the US at this time. In addition, this article did not compare the endothelial cell loss rate observed in this case series with that reported in a comparable case series involving eyes that underwent surgery without the use of intracameral antibiotics. There is an error in the abstract of the article. The abstract stated that the endothelial cell loss rate "was similar to the [sic] reported in other studies of cataract surgery without the use of intracameral prophylaxis." However, in Table 3, all studies listed included the use of intracameral antibiotics (vancomycin, cefuroxime, or moxifloxacin), and, in the discussion, the investigators wrote that this rate was "in the range of that reported in studies on phacoemulsification with intracameral antibiotics (between 3.6% and 18.3%)."
Importantly, this article did not discuss the rate of postoperative endophthalmitis in this series. The use of intracameral antibiotics is widespread in Europe (where an approved package of an antibiotic for intracameral use is available) and in many other parts of the world. The off-label use of intracameral antibiotics is gaining popularity in the US but has not become a standard treatment nationwide. Any off-label use of intracameral medication necessarily increases costs, carries risks of toxicity, and may increase the prevalence of drug-resistant organisms. In our opinion, surgeons in the US should not feel compelled to use intracameral antibiotics (or antibiotic–steroid combinations) at this time.