Expert perspectives and preferences regarding moxifloxacin use in cataract surgery in Indian settings

Objective: To assess current clinical practices, antibiotic preferences, and perceptions regarding the safety, efficacy, and tolerability of moxifloxacin use in cataract surgery among ophthalmologists in India. Methods: The cross-sectional study was conducted using a 23-item, multiple-response questionnaire designed to gather expert opinion from specialists in cataract surgery practicing in Indian settings. The questionnaire included items addressing current prescription practices, clinical observations, treatment preferences, and experiences with moxifloxacin in routine clinical settings for managing post-cataract surgery infections. Results: This study included 308 participants. Approximately 92% of the respondents reported that moxifloxacin is the preferred antibiotic for post-cataract surgery. Most experts (91.88%) stated that they routinely use moxifloxacin eye drops after cataract surgery. About 47% believed that the preoperative use of moxifloxacin eye drops reduces the incidence of postoperative endophthalmitis, while 40% expressed uncertainty or lacked conclusive personal experience or evidence. According to 99% of clinicians, there is no significant increase in inflammation, specifically in terms of anterior chamber cells and flares, on postoperative day 1 following the use of moxifloxacin eye drops. The majority of clinicians (64.61%) rated the tolerability profile of moxifloxacin for the corneal endothelium as excellent, with no adverse events reported on specular microscopy pre- and post-cataract surgery. About 48% of the respondents opined that there is no increased incidence of macular edema, as assessed by optical coherence tomography (OCT), after intracameral moxifloxacin following cataract surgery. Conclusion: Moxifloxacin is widely preferred by Indian ophthalmologists for infection prevention in cataract surgery, with most reporting excellent tolerability, minimal postoperative inflammation, and rare adverse effects on the corneal endothelium or macula.