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Macula toxicity after intravitreal amikacin
A A Seawright1, R D Bourke, R J Cooling
1Retinal Service, Royal Brisbane Hospital, Queensland.
Background:
Although intravitreal aminoglycosides have substantially improved visual prognosis in endophthalmitis, macular infarction may impair full visual recovery.
Methods:
We present a case of presumed amikacin retinal toxicity following treatment with amikacin and vancomycin for alpha-haemolytic streptococcal endophthalmitis.
Results:
Endophthalmitis resolved with improvement in visual acuity to 6/24 at three months. Fundus fluorescein angiography confirmed macular capillary closure and telangiectasis.
Conclusions:
Currently accepted intravitreal antibiotic regimens may cause retinal toxicity and macular ischaemia. Treatment strategies aimed at avoiding retinal toxicity are discussed.
Insights
Intravitreal aminoglycosides can cause retinal toxicity, leading to macular ischemia and vision loss in endophthalmitis patients. New treatment strategies are needed to prevent this complication.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Infectious Diseases
Background:
- Intravitreal aminoglycosides improve endophthalmitis outcomes.
- Macular infarction can limit visual recovery despite treatment.
Observation:
- A case of presumed amikacin retinal toxicity is presented.
- This occurred after treatment for alpha-haemolytic streptococcal endophthalmitis with amikacin and vancomycin.
Findings:
- Endophthalmitis resolved, with visual acuity improving to 6/24.
- Fundus fluorescein angiography revealed macular capillary closure and telangiectasis, indicating retinal toxicity.
Implications:
- Standard intravitreal antibiotic regimens may induce retinal toxicity and macular ischemia.
- Developing treatment strategies to mitigate retinal toxicity is crucial for preserving vision.