Intravitreal treatment of endophtalmitis.

Objectives - The objectives were to determine, from a litterature review, d oses wich can be aministred, toxicity and clinical efficiency of molecules most currently used in intravitreal treatment of endophthalmitis. Those mol ecules are amphotericin B, amikacin, vancomycin and ceftazidim. Method - To realise this literature's review, criteria were: article from a n international review, more than ten patients, administered doses specifie d, clinical efficiency studied. Six articles were complying with those crit eria. Results - Doses commonly used per injection are: 5 mug amphotericin B, 400 mug amikacin, 1 mg vancomycin and 2.25 mg ceftazidim. The most current anti biotics associations are vancomycin/amikacin and vancomycin/ceftazidim. The studied molecules have a good clinical efficiency and are not toxic in dos es commonly used, except amikacin for which several cases of retinal toxici ty have been described. Conclusion - Intraocular toxicity of molecules admisitred by Intravitreal w ay remain controversed and often bad documented but their clinical efficien cy is good. The intravitreal way seems to be even more interesting in the t reatment of endophthalamis, that most of the drugs have not a good diffusio n in vitrea. Nevertheless this literature review showes that clinical studi es give methodological problems (few patients, retrospective studies, syste matic combination of both intravitreal and intravenous treatments). More ra ndomised studies seem necessary to clarify the position of intravitreal tre atment for endophthalmitis. (C) 2001 Editions scientifiques et medicales El sevier SAS.