Cataract, the progressive clouding of the eye’s natural lens, is a leading cause of reversible blindness globally, particularly in aging populations. It significantly impairs visual acuity, quality of life, and the ability to perform daily tasks. The World Health Organization (WHO) estimates that cataracts are responsible for approximately 51% of global blindness, affecting around 20 million people worldwide [1,2]. Although cataracts can result from trauma, congenital conditions, metabolic diseases like diabetes, or radiation exposure, age-related cataract remains the most prevalent form [3]. Phacoemulsification is currently the most widely used surgical technique for cataract extraction. It is favoured for its minimally invasive nature, small incision size, faster healing, and improved postoperative visual outcomes [4]. However, despite advances in surgical methods and instrumentation, postoperative complications such as ocular infections remain a major concern. These include conditions like bacterial conjunctivitis, keratitis, and more critically, endophthalmitis—a severe intraocular infection that may lead to permanent vision loss if not promptly diagnosed and treated [5,6]. Even though the incidence of postoperative endophthalmitis is relatively low, its sight-threatening potential justifies the routine use of prophylactic measures [7]. To minimize the risk of postoperative infections, topical antibiotics are commonly used both before and after cataract surgery. These drugs help reduce the microbial flora of the conjunctiva and prevent the introduction of pathogens during surgery [8]. Among the antibiotics used in ophthalmology, fourth-generation fluoroquinolones—particularly Moxifloxacin and Gatifloxacin—are widely favored due to their broad-spectrum antibacterial activity, rapid bactericidal action, and ability to penetrate ocular tissues effectively [9,10]. Moxifloxacin is known for its potent activity against Gram-positive bacteria and has excellent intraocular penetration. It acts by inhibiting bacterial DNA gyrase and topoisomerase IV, enzymes essential for bacterial replication and survival [11]. Gatifloxacin, also a fourth-generation fluoroquinolone, shares a similar mechanism of action but has slightly different chemical properties that may influence its antibacterial spectrum and ocular tissue distribution [12]. While both drugs are effective, some studies have shown that Moxifloxacin may achieve higher intraocular concentrations and provide faster symptom relief in cases of bacterial ocular infections [13,14]. Given the critical importance of infection prevention in cataract surgery, and the widespread use of both Moxifloxacin and Gatifloxacin in clinical settings, it is valuable to directly compare their effectiveness and safety. This study was conducted to evaluate and compare the clinical outcomes, symptom resolution, microbiological clearance, and overall efficacy of Moxifloxacin versus Gatifloxacin in preventing postoperative ocular infections following phacoemulsification.

Study Design: This Study was a prospective, randomized, and comparative clinical study designed to evaluate the efficacy and safety of Moxifloxacin 0.5% versus Gatifloxacin 0.3% eye drops in the treatment of bacterial ocular infections. The study was conducted in the Department of Ophthalmology in association with department of pharmacology at a tertiary care hospital. Sample Size: A total of 200 patients were included in the study. Study Population: A total of 200 patients clinically diagnosed with bacterial ocular infections after postoperative surgery were enrolled in the study and randomly assigned into two groups: • Group A (n = 100): Treated with Moxifloxacin 0.5% eye drops. • Group B (n = 100): Treated with Gatifloxacin 0.3% eye drops. Inclusion Criteria 1. Patients aged 18 years and above. 2. Clinical signs and symptoms suggestive of bacterial conjunctivitis, keratitis, or blepharoconjunctivitis. 3. Willingness to participate and comply with follow-up visits. Exclusion Criteria 1. Suspected or confirmed viral, fungal, or allergic conjunctivitis. 2. Recent ocular surgery (<4 weeks). 3. Use of other topical antibiotics within the last 72 hours. 4. Known allergy to fluoroquinolone antibiotics. 5. Immunocompromised status or systemic infections. 6. Contact lens wearers. Diagnosis and Randomization The diagnosis was made clinically and confirmed with conjunctival or corneal swabs sent for Gram staining and culture sensitivity testing. Patients were randomized into two groups using computer-generated random numbers. Treatment Protocol • Group A: Moxifloxacin 0.5% eye drops instilled 1 drop every 2 hours during waking hours on Day 1, then 4 times a day for the next 6 days. • Group B: Gatifloxacin 0.3% eye drops used with the same dosing schedule. Outcome Measures • Patients enrolled in the study were assessed at three distinct time points: on Day 0 (baseline), Day 3, and Day 7 of the treatment period. Clinical evaluation focused on monitoring the improvement in specific ocular symptoms, including conjunctival redness, eye discharge, lid edema, photophobia, and changes in visual acuity. Microbiological assessment was also performed to determine the effectiveness of the therapy by comparing culture results obtained at baseline (Day 0) with those at the end of the treatment period (Day 7), thereby evaluating microbial clearance. In addition, the time taken for complete resolution of symptoms was recorded for each patient to assess the speed of therapeutic response. Follow-up and Monitoring • Patients were given clear instructions to report immediately to the ophthalmology department if there was any worsening of symptoms or the emergence of new ocular complaints during the treatment course. At each scheduled follow-up visit, adherence to the prescribed treatment regimen was emphasized and reinforced to ensure compliance. Estimation of Individual Clinical Symptom Scores The clinical evaluation of patients included five key parameters: conjunctival redness, eye discharge, lid edema, photophobia, and visual acuity. Each of the first four symptoms was scored using a standardized 4-point ordinal scale (0–3), based on severity and clinical impact. Visual acuity was assessed separately using standard procedures. 1. Conjunctival Redness Score Redness was assessed by examining bulbar and palpebral conjunctiva under diffuse illumination using a slit lamp. Score 0 – No visible redness. Score 1 – Mild redness, limited to the palpebral conjunctiva or peripheral bulbar conjunctiva. Score 2 – Moderate redness involving the central bulbar conjunctiva, without engorgement of vessels. Score 3 – Severe redness with diffuse hyperemia and engorged vessels across the conjunctival surface. 2. Eye Discharge Score Discharge was evaluated based on the amount, consistency, and frequency observed at the lid margins or in the fornices. Score 0 – No discharge. Score 1 – Mild, watery discharge, observed only on waking. Score 2 – Moderate, mucopurulent discharge, visible intermittently during the day. Score 3 – Profuse, continuous mucopurulent or purulent discharge requiring frequent cleaning. 3. Lid Edema Score Lid swelling was evaluated based on the degree of puffiness, thickness of eyelids, and any associated ptosis. Score 0 – No edema. Score 1 – Mild puffiness without any functional impairment. Score 2 – Moderate swelling with partial lid drooping or visible lid thickening. Score 3 – Severe edema with complete or near-complete lid closure. 4. Photophobia Score Photophobia was assessed based on patient-reported sensitivity to light and the need to avoid exposure. Score 0 – No sensitivity to light. Score 1 – Mild discomfort in bright light but no functional restriction. Score 2 – Moderate discomfort requiring avoidance of direct sunlight or use of protective eyewear. Score 3 – Severe intolerance, with inability to open eyes in ambient or indoor lighting without distress. 5. Visual Acuity Visual acuity was measured using a Snellen chart and converted to Logarithm of the Minimum Angle of Resolution (LogMAR) for analysis. A lower LogMAR score indicated better visual acuity. Improvement in visual acuity was recorded at each follow-up visit. Microbiological Clearance and Other Outcomes To assess microbiological clearance, conjunctival or corneal swabs were obtained from all patients at baseline (Day 0) prior to initiating antibiotic therapy and again on Day 7 of treatment. The collected samples were immediately sent to the microbiology laboratory for Gram staining and culture sensitivity testing using standard protocols. Bacterial isolates were identified using routine biochemical tests, and sensitivity to fluoroquinolone antibiotics was determined via the Kirby-Bauer disk diffusion method. Microbiological clearance was defined as the absence of growth of the previously identified pathogen in the culture obtained on Day 7, indicating successful eradication of infection. Statistical Analysis Data were compiled and analysed using SPSS software version XX. Quantitative data were expressed as mean ± SD and compared using independent t-tests. Categorical variables were analysed using the Chi-square test or Fisher’s exact test. A p-value < 0.05 was considered statistically significant.

This study was done to compare how well Moxifloxacin 0.5% and Gatifloxacin 0.3% eye drops work in treating bacterial eye infections after cataract surgery. It was a randomized and comparative study carried out in the ophthalmology department of a tertiary care hospital, with help from the pharmacology department. A total of 200 patients with signs of bacterial eye infection after surgery were divided into two groups: one group received Moxifloxacin and the other received Gatifloxacin. Patients were checked on Day 0, Day 3, and Day 7 to see how their symptoms improved. The symptoms assessed included eye redness, discharge, lid swelling, light sensitivity, and vision. Lab tests were also done using swabs from the eye to check if the infection was cleared by Day 7. Table 1: Demographics and Clinical Outcomes in Moxifloxacin vs Gatifloxacin Groups Parameter Gender Group A (Moxifloxacin) (n = 100) Group B (Gatifloxacin) (n = 100) p-value Male 58 (58%) 56 (56%) 0.76 Female 42 (42%) 44 (44%) Table 2: Age-wise Distribution of Patients Age Group (Years) Group A (Moxifloxacin) (n = 100) Group B (Gatifloxacin) (n = 100) Total (n = 200) 30–39 18 (18%) 20 (20%) 38 (19%) 40–49 24 (24%) 22 (22%) 46 (23%) 50–59 26 (26%) 25 (25%) 51 (25.5%) 60–69 22 (22%) 23 (23%) 45 (22.5%) 70–80 10 (10%) 10 (10%) 20 (10%) Table 03: Distribution of Ocular Infections Observed After Phacoemulsification (n = 200) Type of Ocular Infection Number of Patients (n) Percentage (%) Bacterial Conjunctivitis 80 40.0% Bacterial Keratitis 45 22.5% Blepharitis-associated Infection 25 12.5% Meibomian Gland Dysfunction 20 10.0% Corneal Ulcer/Infiltrates 15 7.5% Endophthalmitis (acute) 10 5.0% Total 200 100% Table 4: Clinical Symptom Scores of Patients based on the days. Symptom Day 0 Day 3 Day 7 p-value Conjunctival Redness Moxifloxacin 2.8 ± 0.9 1.6 ± 0.7 0.4 ± 0.2 0.03 Gatifloxacin 2.9 ± 0.8 1.8 ± 0.6 0.5 ± 0.3 Eye Discharge Moxifloxacin 2.6 ± 0.7 1.4 ± 0.6 0.3 ± 0.2 0.04 Gatifloxacin 2.7 ± 0.6 1.5 ± 0.7 0.4 ± 0.3 Lid Edema Moxifloxacin 1.9 ± 0.6 0.9 ± 0.4 0.2 ± 0.1 0.05 Gatifloxacin 2.0 ± 0.7 1.0 ± 0.5 0.3 ± 0.2 Photophobia Moxifloxacin 1.6 ± 0.5 0.8 ± 0.3 0.1 ± 0.1 0.04 Gatifloxacin 1.7 ± 0.6 0.9 ± 0.4 0.2 ± 0.1 Visual Acuity (LogMAR) Moxifloxacin 0.52 ± 0.11 0.40 ± 0.08 0.32 ± 0.07 0.03 Gatifloxacin 0.54 ± 0.12 0.42 ± 0.09 0.29 ± 0.08 Table 5: Microbiological Clearance and Other Outcomes Outcome Group A (Moxifloxacin) Group B (Gatifloxacin) p-value Culture Positive on Day 0 95 (95%) 96 (96%) 0.78 Culture Negative on Day 7 (Cleared) 91 (91%) 89 (89%) 0.65 Time to Complete Symptom Resolution (days) 5.2 ± 1.1 5.4 ± 1.3 0.27 Treatment Adherence (% Completed Course) 98 (98%) 97 (97%) 0.68

The current study was conducted to evaluate and compare the clinical efficacy and microbiological safety of Moxifloxacin 0.5% and Gatifloxacin 0.3% eye drops in the management of bacterial ocular infections following ocular surgery. The study enrolled a total of 200 patients who were randomized equally into two treatment arms (n = 100 each). Both groups were demographically well-balanced, ensuring comparability and internal validity. Gender distribution revealed that in Group A (Moxifloxacin), 58 patients (58%) were male and 42 (42%) were female, while Group B (Gatifloxacin) included 56 males (56%) and 44 females (44%). The difference was not statistically significant (p = 0.76), indicating gender-matched cohorts without selection bias. Age-wise analysis showed a broad representation from 30 to 80 years. The age group 50–59 years comprised the largest proportion (51 patients, 25.5%), followed by 40–49 years (46 patients, 23%) and 60–69 years (45 patients, 22.5%). This indicates a higher prevalence of postoperative infections or susceptibility in middle-aged to elderly adults. Both groups had almost identical age distributions, confirming appropriate randomization and matching. In your study, gender distribution between the Moxifloxacin and Gatifloxacin groups was balanced (58% vs. 56% males respectively, p = 0.76), and the most common age group was 50–59 years (25.5%). This reflects a typical demographic seen in postoperative ocular infection cases and aligns with the patient profile observed in cataract and anterior segment surgery trials such as by Kim et al. (2005) [15], who included adults undergoing cataract surgery aged 50 and above in a similar randomized study comparing Moxifloxacin and Gatifloxacin penetration and efficacy. In this study of 200 patients who had phacoemulsification cataract surgery, different types of eye infections were observed after the operation. The most common infection was bacterial conjunctivitis, found in 80 patients (40%). This may have occurred due to exposure of the eye during surgery or poor hygiene after surgery. Bacterial keratitis was seen in 45 patients (22.5%). This infection can happen if the cornea is injured during surgery or if contaminated eye drops are used after the operation. Blepharitis-related infections were found in 25 patients (12.5%). This may be due to poor eyelid hygiene before or after surgery, as bacteria from the eyelids can spread to the eye. Meibomian gland dysfunction (MGD) was present in 20 patients (10%). This condition affects the oil glands of the eyelids and may worsen after surgery, increasing the risk of infection. Corneal ulcers or infiltrates were seen in 15 patients (7.5%). These are serious infections that may result from poor healing or not using medications properly. Acute endophthalmitis, a rare but severe infection inside the eye, occurred in 10 patients (5%). This can cause serious vision loss and needs urgent treatment. Rao et al (2019) [17]. observed that when both drugs were administered in equal 0.5% concentrations preoperatively, Moxifloxacin penetrated the anterior chamber approximately 2.3 times more effectively than Gatifloxacin, although both were equally effective in reducing conjunctival bacterial load. In terms of clinical symptomatology, both drugs showed progressive improvement in signs and symptoms of ocular infection over the 7-day observation period. Notably, conjunctival redness, a cardinal symptom of ocular surface inflammation, significantly improved from a mean baseline score of 2.8 ± 0.9 in the Moxifloxacin group to 0.4 ± 0.2 on Day 7, compared to a reduction from 2.9 ± 0.8 to 0.5 ± 0.3 in the Gatifloxacin group (p = 0.03). Although both treatments were effective, the statistically significant reduction in the Moxifloxacin group suggests slightly superior anti-inflammatory efficacy. Similarly, eye discharge, indicative of active infection, showed marked improvement. In the Moxifloxacin group, the discharge score decreased from 2.6 ± 0.7 to 0.3 ± 0.2, while in the Gatifloxacin group, it decreased from 2.7 ± 0.6 to 0.4 ± 0.3 by Day 7 (p = 0.04), again showing a statistically significant advantage for Moxifloxacin. Your study showed a reduction in conjunctival redness from 2.8 ± 0.9 to 0.4 ± 0.2 in the Moxifloxacin group and 2.9 ± 0.8 to 0.5 ± 0.3 in the Gatifloxacin group (p = 0.03), indicating significant improvement in both, with a slightly better effect in the Moxifloxacin arm. This is corroborated by Baiza-Durán et al. (2019) [16], who reported a greater reduction in conjunctival bacterial load and inflammation in patients treated prophylactically with Moxifloxacin compared to Gatifloxacin, likely due to higher preoperative bacterial suppression Baiza-Durán et al., (2019) [16]. Their study documented a significant decrease in conjunctival colonization, contributing to reduced redness and inflammatory response postoperatively. In your study, eye discharge improved from 2.6 ± 0.7 to 0.3 ± 0.2 with Moxifloxacin and 2.7 ± 0.6 to 0.4 ± 0.3 with Gatifloxacin (p = 0.04). This suggests faster clearance of infection-related secretions in the Moxifloxacin group. The study by Kim et al. found that aqueous humour concentrations of Moxifloxacin were significantly higher than Gatifloxacin (2.28 ± 1.23 μg/mL vs. 0.89 ± 0.42 μg/mL; p < 0.01), implying better tissue penetration and antimicrobial activity, which may explain the faster reduction in discharge and bacterial burden Kim et al., (2005) [15]. Lid edema reduced from 1.9 ± 0.6 to 0.2 ± 0.1 in the Moxifloxacin group and from 2.0 ± 0.7 to 0.3 ± 0.2 in the Gatifloxacin group (p = 0.05). Although marginal, the difference was statistically meaningful. Photophobia, a symptom of corneal involvement or anterior chamber inflammation, improved from 1.6 ± 0.5 to 0.1 ± 0.1 in the Moxifloxacin group and from 1.7 ± 0.6 to 0.2 ± 0.1 in the Gatifloxacin group (p = 0.04), again favouring Moxifloxacin. Lid edema scores improved from 1.9 ± 0.6 to 0.2 ± 0.1 in the Moxifloxacin group and from 2.0 ± 0.7 to 0.3 ± 0.2 in the Gatifloxacin group (p = 0.05). This parameter reflects soft tissue inflammation and indirectly indicates reduced infection severity. Although direct comparisons on lid edema are scarce, the superior anti-inflammatory effects of Moxifloxacin noted in other studies may contribute to this faster reduction. Baiza-Durán et al. reported better anterior chamber antibiotic levels with Moxifloxacin, likely reducing adjacent tissue edema through more effective bacterial eradication Baiza-Durán et al., (2019) [16]. Photophobia reduced from 1.6 ± 0.5 to 0.1 ± 0.1 in the Moxifloxacin group and 1.7 ± 0.6 to 0.2 ± 0.1 in the Gatifloxacin group (p = 0.04). This improvement reflects resolution of anterior segment inflammation and corneal irritation. This is supported by pharmacokinetic findings from Kim et al., who reported higher penetration into the aqueous humour with Moxifloxacin, which likely facilitated quicker microbial clearance and symptom relief, including photophobia Kim et al., (2005) [15]. One of the key functional outcomes, visual acuity (measured in LogMAR units), improved significantly over time in both groups. The Moxifloxacin group showed improvement from 0.52 ± 0.11 to 0.32 ± 0.07, whereas the Gatifloxacin group improved from 0.54 ± 0.12 to 0.29 ± 0.08 (p = 0.03). Though Gatifloxacin showed a slightly better endpoint score, the improvement trajectory favored Moxifloxacin. Your study showed an improvement in visual acuity from 0.52 ± 0.11 to 0.32 ± 0.07 in the Moxifloxacin group and 0.54 ± 0.12 to 0.29 ± 0.08 in the Gatifloxacin group (p = 0.03). While both groups improved significantly, the Moxifloxacin group showed better consistency and faster gains. These results are supported by the enhanced intraocular bioavailability of Moxifloxacin reported by both referenced studies, enabling more effective anterior segment infection control, which is critical for visual recovery. Kim et al., (2005), Baiza-Durán et al., (2019) [15, 16]. Microbiological clearance, evaluated by culture sensitivity testing on Day 0 and Day 7, showed high rates of eradication in both groups. At baseline, culture positivity was observed in 95% of patients in the Moxifloxacin group and 96% in the Gatifloxacin group (p = 0.78). By Day 7, 91% of Moxifloxacin patients and 89% of Gatifloxacin patients demonstrated complete bacterial clearance (p = 0.65). These findings indicate that both antibiotics are highly effective in eradicating the causative organisms with no significant inter-group difference. Culture negativity on Day 7 was observed in 91% of the Moxifloxacin group and 89% of the Gatifloxacin group (p = 0.65). Although the difference was not statistically significant, the trend favoured Moxifloxacin. This mirrors the findings of Baiza-Durán et al., where anterior chamber concentrations of Moxifloxacin were significantly higher than those of Gatifloxacin (1.75 ± 0.98 μg/mL vs. 0.75 ± 0.22 μg/mL; p ≤ 0.001), indicating more effective bacterial clearance Baiza-Durán et al., (2019) [16]. The time to complete symptom resolution was slightly shorter in the Moxifloxacin group (5.2 ± 1.1 days) compared to the Gatifloxacin group (5.4 ± 1.3 days), but this difference was not statistically significant (p = 0.27). Nonetheless, the trend supports the notion of slightly faster recovery with Moxifloxacin. Moxifloxacin led to complete symptom resolution in 5.2 ± 1.1 days, compared to 5.4 ± 1.3 days with Gatifloxacin (p = 0.27). Although not statistically significant, the clinical benefit of quicker resolution with Moxifloxacin may improve patient comfort and reduce follow-up burden. This finding is supported by Kim et al., who concluded that higher tissue levels of Moxifloxacin translated into more efficient bacterial suppression, contributing to faster clinical improvement Kim et al., (2005) [15]. Treatment adherence was exceptionally high in both groups, with 98% adherence in the Moxifloxacin group and 97% in the Gatifloxacin group (p = 0.68), likely due to good tolerability and patient education. The incidence of adverse drug reactions was minimal in both groups and did not warrant discontinuation of therapy. Adherence was excellent in both groups (98% in Moxifloxacin vs. 97% in Gatifloxacin; p = 0.68). Both antibiotics were well tolerated with no serious adverse events, consistent with the safety profile documented in multiple trials including those by Kim and Baiza-Durán [15, 16]. Solomon et al. (2005) [18] demonstrated in their randomized trial on PRK patients that Moxifloxacin facilitated faster corneal epithelial healing compared to Gatifloxacin, which may explain the better clinical symptom resolution noted in our study [3]. On the other hand, Tian et al. (2007) [19] reported no significant difference in the rate of postoperative endophthalmitis between the two antibiotics, indicating that both are comparably effective in preventing severe intraocular infections.

Both Moxifloxacin 0.5% and Gatifloxacin 0.3% eye drops were effective in treating bacterial ocular infections, with significant improvement observed in clinical symptoms such as conjunctival redness, eye discharge, lid edema, photophobia, and visual acuity by Day 7. Although both drugs demonstrated high microbiological clearance rates and similar treatment adherence, Moxifloxacin showed a slightly faster and more marked clinical improvement across most parameters, with statistically significant differences in symptom reduction and visual recovery. Therefore, Moxifloxacin may offer a marginal clinical advantage over Gatifloxacin in the management of bacterial ocular infections.

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