Moxifloxacin + Dexamethasone Dosing After Cataract Surgery
For combined moxifloxacin 0.5%/dexamethasone 0.1% eyedrops (fixed combination), instill one drop in the affected eye 4 times daily for 15 days postoperatively. 1
Standard Dosing Regimen
When using the fixed combination formulation:
- Administer 4 times daily for 15 days following phacoemulsification and IOL implantation 1
- This provides equivalent efficacy to separate administration of moxifloxacin and dexamethasone drops 1
- The combination effectively prevents infection and controls inflammation with no cases of endophthalmitis reported in clinical trials 1
Alternative Approach: Separate Formulations
If using individual medications rather than the fixed combination:
- Moxifloxacin 0.5%: 3 times daily for 7 days (per FDA labeling) 2
- Dexamethasone or prednisolone acetate 1%: 4 times daily, tapered over 3-5 weeks 3
Critical Formulation Considerations
Strongly prioritize preservative-free formulations to minimize ocular surface toxicity, particularly in high-risk patients 3, 4:
- Patients with pre-existing dry eye disease 3
- Those using multiple concurrent topical medications 3
- Diabetic patients 3
- History of cataract surgery-induced dry eye 3
Monitoring Schedule
Follow-up assessments should occur at:
- Day 1: Check for infection, inflammation, and anterior chamber reaction 3, 5
- Weeks 1-2: Assess for infection, dry eye, ocular surface damage 3, 4
- 1 month: Evaluate treatment effect and intraocular pressure 3, 4
- 2-3 months: Monitor for delayed complications 3
Common Pitfalls to Avoid
- Using preserved drops in high-risk patients significantly increases ocular surface toxicity risk 3
- Inadequate IOP monitoring with prolonged corticosteroid use can lead to steroid-induced glaucoma 3
- Extending corticosteroid duration beyond necessary increases risk of IOP elevation without additional benefit 3
- Failing to taper corticosteroids appropriately may cause rebound inflammation 3
Evidence Quality Note
The fixed combination moxifloxacin/dexamethasone demonstrates equivalent efficacy to conventional separate drop therapy with 97% of patients achieving ≤5 anterior chamber cells by day 15, with no infectious complications in either group 1. Recent studies on intracameral delivery show promise for reducing drop burden 6, 7, 8, but the standard topical regimen remains the established approach per current guidelines 3.