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September 1984

Intravitreal Moxalactam-Reply

Author Affiliations

Los Angeles

Arch Ophthalmol. 1984;102(9):1268. doi:10.1001/archopht.1984.01040031027010

In Reply.  —We agree with the findings of Leeds et al regarding the safe dose of intravitreal moxalactam. The importance of using moxalactam in a specific, localized intravitreal injection has been recently underscored by the reports of bleeding complications in some patients who have received systemic moxalactam.1,2 Moxalactam and preprothrombin share a structural similarity. This structural similarity may cause inhibition of prothrombin formation. Another theory of moxalactam-related bleeding may be that the intestinal flora is destroyed by the antibiotic, resulting in a deficiency of vitamin K—dependent clotting factors. Moxalactam may further prolong bleeding time by interfering with platelet aggregation. We have not found hemorrhaging to be a problem when moxalactam was administered intravitreally. This is most probably due to the very small doses used in a localized area.The advantage of moxalactam is its broad spectrum, which includes both staphylococci, as pointed out by Leeds et al, but, even

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