Intravitreal treatment of endophthalmitis

Objectives - The objectives were to determine, from a literature review, th e dosage which can be administered, the toxicity, and the clinical efficacy of the most commonly used molecules in the intravitreal treatment of endop hthalmitis. Those molecules are amphotericin B, amikacin, vancomycin, and, ceftazidime. Method - This literature review was made according to the following criteri a: the article had to come from an international magazine, to concern more than ten patients, administered dosage had to be specified, and clinical ef ficiency studied. Six articles were reviewed with these criteria. Results - The dosage commonly used per injection was: 5 mug amphotericin B, 400 mug amikacin, 1 mg vancomycin, and 2.25 mg ceftazidime. The most commo n antibiotic combinations were vancomycin/amikacin and vancomycin/ceftazidi m. The studied molecules had a good clinical efficacy and were not toxic wi th the commonly used dosage, except for amikacin for which several cases of retinal toxicity were described. Conclusion - The intraocular toxicity of molecules administered by the intr avitreal way remains controversial and often badly documented but the clini cal efficiency of these molecules is good. The intravitreal way seems to be especially interesting in the treatment of endophthalmitis, because most o f the other drugs do not have a good diffusion in vitrea. Nevertheless this literature review showed that clinical studies raise methodological proble ms (too few patients, studies were retrospective, there was a systematic co mbination of both intravitreal and intravenous treatments). A greater numbe r of randomized studies seem necessary to better assess intravitreal treatm ent for endophthalmitis. (C) 2001 Editions scientifiques et medicales Elsev ier SAS.