Intracameral Antibiotic

The evidence base for intracameral injection includes the large series listed above in slide 1. Most of the studies compared a topical antibiotic group with intracameral injection plus topical antibiotic.

Slide 2 shows the low endophthalmitis rates reported with intracameral antibiotic injection.

Increasingly, studies are being published examining infection rates with intracameral injection alone, without an additional topical antibiotic (slide 3). Recent meta-analyses and review studies (boxed studies in slide 3) conclude that there is no benefit to adding topical antibiotic drops to intracameral injection.

• Bowen et al Br J Ophthalmol 2018;102:1268-76

• Kessel et al. Acta Ophthalmol 2015;93:303-17

Published studies to date do not indicate superiority between the most commonly injected antibiotics, cefuroxime and moxifloxacin. 

1. 1. Shorstein et al, Am J Ophthalmol 2021; 227:166-72

   2. Friling et al, J Cat Refr Surg 2013; 39:15-21

   3. Rathi et al; Indian J Ophthalm 2020; 68:819-24

• The most common intracameral antibiotic agent injected in the US

• Correct dosing is important to prevent TASS, corneal decompensation or increased risk of endophthalmitis

• 1. Inject 0.1 mL of moxifloxacin 0.5% (topical Vigamox bottle strength)

     • Do not use this strength for stromal hydration.

                                      or

• 2. Inject 0.5 mL of moxifloxacin 0.1% (diluted)

     • Stromal hydration has been safely used at this concentration.

• 3. Both injection strategies deliver about 500 µg moxifloxacin. The final concentration of drug in the eye with Method 1 (and thus, bactericidal activity) will depend on the patient's postop anterior chamber volume, whereas with Method 2, by replacing nearly all of the aqueous with diluted moxifloxacin, a more consistent drug concentration is more likely achieved following injection.

There is no FDA approved intracameral agent in the US. Moxifloxacin must be compounded.

• Drawing up moxifloxacin 0.5% from a newly opened Vigamox bottle and injecting 0.1 mL

• Diluting 0.5% moxifloxacin to make 0.1%

• Ordering individual units from a 503A pharmacy

• Ordering in bulk from a 503B outsourcing facility