Incidence of post-traumatic endophthalmitis following repaired open globe injury: impact of prophylactic intracameral moxifloxacin

BACKGROUND/OBJECTIVES: To assess the effect of intracameral moxifloxacin (ICM) after repaired open globe injury (OGI) in reducing the incidence of post-traumatic endophthalmitis. SUBJECTS/METHODS: Ambispective, consecutive, comparative study of patients operated of OGI repair. Patients were divided into two groups: those without intracameral antibiotic prophylaxis (No-ICM) (operated between 2002 and 2012) and those with ICM prophylaxis at the end of the procedure (ICM) (operated between 2013 and 2023). Both received standard povidone-iodine antisepsis. Endophthalmitis was defined as severe intraocular inflammation associated with hypopyon and/or vitritis. RESULTS: 424 eyes (424 patients) were included, 294 in ICM group and 130 in No-ICM group. Male sex was 85.7% and 90.8% in ICM and No-ICM groups, respectively. The ICM group was significantly older than No-ICM group (median (IQR): 26 (14-41) vs. 21.5 (12-34), p = 0.025). The proportion of patients younger than 18 years was similar between ICM and No-ICM group (33.1% vs. 38.5%, p = 0.275). Post-traumatic endophthalmitis was significantly lower in ICM (2/294, 0.7%) compared to No-ICM (5/130, 3.9%) (p = 0.031) group. Sensitivity analysis age-adjusted confirmed the protective effect of ICM for endophthalmitis after OGI was independent of age (adjusted OR: 0.20; 95% CI: 0.04-0.86; p = 0.031). The relative risk of endophthalmitis with ICM compared with no-ICM was 0.18 (0.04-0.78), with relative risk reduction of 82%, absolute risk reduction of 3.2%, and a number needed to treat of 32 to prevent one case of endophthalmitis following OGI repair. CONCLUSIONS: ICM at the end of surgery reduces the incidence of post-traumatic endophthalmitis after OGI repair, compared with no intracameral antibiotic prophylaxis.