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Aminoglycoside toxicity--a survey of retinal specialists. Implications for ocular use
1Department of Ophthalmology, University of Virginia Health Sciences Center, Charlottesville 22908.
Abstract:
Surveyed members of the Retina, Macula, and Vitreous Societies reported 93 cases of macular infarction they believed to be related to administration of gentamicin sulfate; five, to administration of amikacin sulfate; and three, to administration of tobramycin sulfate. Most cases of infarction after administration of gentamicin occurred in eyes that received an intravitreous injection of 0.4 mg after vitrectomy, but a surprisingly high number, 17, occurred after injection of 0.1 or 0.2 mg, doses that are considered safe by many ophthalmologists. Four additional cases of infarction occurred in eyes that did not undergo vitrectomy after injection of 0.1 or 0.2 mg. Four of the five cases related to administration of amikacin occurred after intravitreous injection of 0.4 mg, and one of these four occurred in an eye that did not undergo vitrectomy. Twenty-three cases of macular infarction occurred in eyes that were treated with prophylactic subconjunctival injections of aminoglycosides after routine ocular surgery. Responses from this survey suggest that aminoglycoside-induced retinal infarction is widely recognized and more common than indicated from the small number of cases reported in the literature. The role of aminoglycosides in the prophylaxis of ocular infections and the management of endophthalmitis should be reevaluated.
Insights
Aminoglycoside antibiotics, like gentamicin, may cause macular infarction, even at low doses or without vitrectomy. This risk necessitates reevaluating their use in eye infections and prophylaxis.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Pharmacology
Background:
- Aminoglycosides are commonly used for ocular infections and prophylaxis.
- Retinal infarction is a serious complication that can lead to vision loss.
Purpose of the Study:
- To investigate the incidence and risk factors of aminoglycoside-induced macular infarction.
- To assess the safety of commonly used aminoglycoside doses and administration routes.
Main Methods:
- A survey was conducted among members of the Retina, Macula, and Vitreous Societies.
- Collected data on cases of macular infarction suspected to be related to aminoglycoside administration.
Main Results:
- 93 cases linked to gentamicin, 5 to amikacin, and 3 to tobramycin were reported.
- Macular infarction occurred even with low-dose gentamicin injections (0.1-0.2 mg) and in eyes without vitrectomy.
- 23 cases resulted from prophylactic subconjunctival aminoglycoside injections.
Conclusions:
- Aminoglycoside-induced retinal infarction is more prevalent than previously reported.
- The safety profile of aminoglycosides in ophthalmology requires reevaluation.
- Current practices for aminoglycoside use in prophylaxis and endophthalmitis management should be reconsidered.