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Intravitreal vancomycin. Retinal toxicity, clearance, and interaction with gentamicin.
Archives of Ophthalmology (Chicago, Ill. : 1960)
|June 1, 1987
Summary
Vancomycin is effective against resistant gram-positive bacteria causing endophthalmitis. Intravitreal vancomycin is safe in rabbits, with clearance rates varying by eye condition, supporting its use with aminoglycosides.
Area of Science:
- Ophthalmology
- Microbiology
- Pharmacology
Background:
- Gram-positive bacteria causing exogenous bacterial endophthalmitis exhibit resistance to cefazolin and gentamicin.
- Vancomycin demonstrates consistent sensitivity against these resistant isolates.
Purpose of the Study:
- To reevaluate the retinal toxicity of intravitreal vancomycin.
- To assess vancomycin clearance in rabbit eyes with varying surgical conditions.
- To investigate the synergistic effects of vancomycin and gentamicin.
Main Methods:
- Pigmented rabbits were used to test intravitreal vancomycin toxicity and clearance.
- Toxicity was assessed at doses up to 2 mg in phakic and aphakic-vitrectomized eyes.
- Clearance rates were measured in eyes with intact or absent lens capsules.
Main Results:
- Intravitreal vancomycin up to 2 mg was found to be non-toxic.
- Vancomycin clearance was slowest in phakic eyes and fastest in aphakic-vitrectomized eyes without intact lens capsules.
- Vancomycin and gentamicin demonstrated additive or synergistic interactions against bacterial isolates.
Conclusions:
- Intravitreal vancomycin is a safe and effective treatment option for bacterial endophthalmitis.
- Clearance kinetics are influenced by ocular anatomy, particularly the presence of the lens and vitreous.
- Combination therapy with vancomycin and an aminoglycoside is recommended for initial treatment of exogenous bacterial endophthalmitis.