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

Why protecting injured eyes matters

When the surface of the eye is cut open by an accident, sight can be lost not only from the injury itself but also from a severe infection that sometimes follows. This paper looks at whether placing an antibiotic directly inside the eye at the end of emergency repair surgery can lower the odds of that dangerous infection, helping more people keep their vision after serious eye trauma.

A closer look at a rare but serious eye infection

The infection studied here is called endophthalmitis, a fierce inflammation that develops when germs get inside the eye. It can strike after any eye operation, but the risk is much higher after a traumatic open globe injury, where a sharp object or flying fragment actually pierces the eyeball. In such cases, the eye is already damaged and contaminated, and any added infection can turn a hard situation into permanent blindness. Doctors already use iodine on the eye surface during surgery and sometimes apply antibiotics in different ways, but it has not been clear how well placing medicine directly into the front chamber of the eye works after trauma repair.

How the study was designed

The research team at a university hospital in Monterrey, Mexico, reviewed over two decades of patients who needed surgery to repair an open globe injury. They compared two groups treated at the same center under similar conditions. In the earlier years, patients received careful cleaning with iodine but no antibiotic placed inside the eye during surgery. In the later years, surgeons added a small dose of the antibiotic moxifloxacin directly into the front of the eye at the end of every repair. The study included 424 injured eyes, and the team tracked who later developed the telltale signs of severe infection inside the eye over at least two weeks of follow up.

What the numbers showed

The difference between the two groups was striking, even though the overall infection rate remained low. Among 130 eyes that did not receive the inside-the-eye antibiotic, 5 developed endophthalmitis, about 4 out of every 100 cases. Among 294 eyes that did receive intracameral moxifloxacin, only 2 developed this infection, less than 1 out of every 100. The authors calculated that this represented an 82 percent relative drop in risk. Put another way, if 32 patients with similar injuries all received the antibiotic during surgery, one case of this dangerous infection would likely be prevented. The benefit held up even after adjusting for age, and it appeared despite the fact that the treated group actually had more known risk factors, such as longer delays before repair and more frequent presence of foreign material inside the eye.

Placing the findings in context

Earlier work in cataract operations had already shown that putting antibiotics directly into the eye at the end of surgery can cut infection rates. However, those procedures are planned and clean, unlike sudden traumatic eye wounds. Evidence for the same strategy in trauma cases has been sparse, and no previous study had focused on moxifloxacin in this setting. By drawing on many years of real-world experience, this study helps fill that gap, indicating that adding a small amount of this drug into the eye is both practical and likely protective when surgeons are closing a serious eye wound.

What this means for patients with eye injuries

For people who suffer a deep eye injury, the risk of losing vision from infection is a constant worry, even after expert surgical repair. This study suggests that a simple extra step during surgery placing an antibiotic directly inside the eye can meaningfully lower that risk. While no method can prevent every infection and some germs, like certain fungi, may not respond to the drug used here, the results support making intracameral antibiotic use a routine part of repairing open globe injuries, much as it is for modern cataract surgery. For patients, that could translate into a better chance of keeping useful sight after a life changing eye accident.

Citation: Mohamed-Noriega, K., Hernández-Moreno, A.J., Morales-Wong, F. et al. Incidence of post-traumatic endophthalmitis following repaired open globe injury: impact of prophylactic intracameral moxifloxacin. Eye 40, 1030–1036 (2026). https://doi.org/10.1038/s41433-026-04338-y

Keywords: open globe injury, eye infection, endophthalmitis, intracameral moxifloxacin, ocular trauma