Table 1_Intracameral moxifloxacin for endophthalmitis prophylaxis after cataract surgery: a systematic review and meta-analysis.docx

BackgroundPostoperative endophthalmitis is a devastating complication of cataract surgery. Intracameral moxifloxacin has emerged as a promising prophylactic strategy due to its broad-spectrum properties and pre-formulated preparations. However, a robust synthesis of evidence from randomized controlled trials (RCTs) is needed to confirm its efficacy and safety.
MethodsA systematic review and meta-analysis were conducted using evidence from PubMed, Scopus, Web of Science, and CENTRAL, including RCTs published up to August 2025. The primary outcome was the incidence of endophthalmitis, while secondary outcomes included endothelial cell count (ECC) and central corneal thickness (CCT). We pooled outcomes using risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) using Stata (version 18).
ResultsA total of six RCTs involving 4,438 patients were included. Overall, one RCT demonstrated a low risk of bias, three RCTs raised some concerns, and two RCTs were assessed as having a high risk of bias. Intracameral moxifloxacin significantly reduced the incidence of postoperative endophthalmitis compared to the control group (n = 5 RCTs, RR: 0.22, 95% CI [0.07, 0.77], p = 0.02). A sensitivity analysis excluding studies with a high risk of bias demonstrated that the effect remained statistically significant (n = 3 RCTs, RR: 0.183, 95% CI 0.038, 0.874, p = 0.03), with no evidence of heterogeneity (I2 = 0%, p = 0.65). There was no significant difference between the moxifloxacin and control groups regarding postoperative changes in ECC (n = 3 RCTs, MD: 22.17, 95% CI [−8.53, 52.88], p = 0.16) or CCT (n = 3 RCTs, MD: -0.03, 95% CI [−0.36, 0.31], p = 0.88).
ConclusionProphylactic intracameral moxifloxacin significantly reduces the incidence of postoperative endophthalmitis following cataract surgery. This substantial protective benefit is achieved without evidence of compromised endothelial safety; however, safety conclusions are limited by the small number of patients assessed and should be interpreted with caution.
Systematic review registrationThe study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD420251144067), https://www.crd.york.ac.uk/PROSPERO/view/CRD420251144067.

背景：术后眼内炎是白内障手术极具破坏性的并发症。前房内注射莫西沙星因其广谱抗菌特性与预配制制剂，已成为颇具前景的预防策略。然而，仍需对随机对照试验（RCT）的证据开展严谨整合，以确证其有效性与安全性。
方法：本研究针对截至2025年8月发表于PubMed、Scopus、Web of Science及CENTRAL数据库的随机对照试验，开展系统评价与meta分析。主要结局指标为眼内炎发生率，次要结局指标包括内皮细胞计数（ECC）与中央角膜厚度（CCT）。采用Stata（18版）软件，以风险比（RRs）、均数差（MDs）结合95%置信区间（CIs）合并分析结局数据。
结果：最终纳入6项随机对照试验，共涉及4438例患者。其中1项试验偏倚风险较低，3项试验存在一定方法学顾虑，2项试验偏倚风险较高。与对照组相比，前房内注射莫西沙星可显著降低术后眼内炎发生率（5项试验，RR=0.22，95%CI[0.07, 0.77]，p=0.02）。剔除偏倚风险较高的研究后进行敏感性分析，结果仍具有统计学意义（3项试验，RR=0.183，95%CI[0.038, 0.874]，p=0.03），且未发现异质性证据（I²=0%，p=0.65）。莫西沙星组与对照组在术后内皮细胞计数变化（3项试验，MD=22.17，95%CI[−8.53, 52.88]，p=0.16）或中央角膜厚度变化（3项试验，MD=-0.03，95%CI[−0.36, 0.31]，p=0.88）方面均无显著差异。
结论：预防性前房内注射莫西沙星可显著降低白内障术后眼内炎的发生率。该显著保护效应未伴随内皮安全性受损的证据；然而，由于纳入研究的患者数量有限，安全性结论存在局限性，解读时需谨慎。
系统评价注册：本研究已在国际系统评价前瞻注册库（PROSPERO）注册（编号：CRD420251144067），注册网址：https://www.crd.york.ac.uk/PROSPERO/view/CRD420251144067。