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Role of Systemic Antibiotics versus Intravitreal Antibiotics in Treatment of Endophthalmitis: Presented at AAO

By Earl R. Nichols

CHICAGO, IL -- October 25, 2005 --The incidence of endophthalmitis has fallen markedly in recent years, partly due to the development of newer antibiotics that can be used post-cataract surgery. However, until recently, the main treatment has been intravitreal injections of either vancomycin or amikacin, and there is still some debate as to how well oral or topical antibiotics would be absorbed within the eye.

Therefore, intravitreal injections may remain the treatment of choice for the time being, according to William Mieler, MD, Chairman, Department of Ophthalmology, University of Chicago, Chicago, Illinois, United States.

A large trial conducted from 1991 to 1994 showed little or no benefit to systemic antibiotics compared with a control group. The antibiotics, it turned out, were not effective at entering the eye and therefore, their use was limited.

The advent of oral antibiotics though, may change this paradigm, since oral drugs were not studied in the earlier report, Dr. Mieler said.

Over the past 2 years, newer fourth-generation fluoroquinolones such as gatifloxacin and moxifloxacin have been shown to readily penetrate into the vitreous cavity when administered systemically, Dr. Mieler said in a presentation here on October 18^th at the American Academy of Ophthalmology (AAO) Retina sub-specialty day symposium.

However, "it is not known if treatment alone with oral antibiotics would be adequate to fully treat and contain an infection," he noted. It may be that oral antibiotics should be considered as a supplement to vitrectomy surgery alone with the concomitant administration of intravitreal antibiotics.

Topical antibiotics have never been proven to be very effective. However, a recent study showed that moxifloxacin administered every 2 hours for 3 days resulted in some "modest" vitreous penetration in non-inflammed phakic eyes, Dr. Mieler said. This provided adequate coverage against staphylococcus coagulase-negative organisms and some Gram-negative organisms as well.

Again, he said, it is not likely that this route of administration would be adequate for use as monotherapy.

Dr. Mieler noted that the incidence of endophthalmitis is declining, and is now less than 0.5% after cataract surgery, but it is still more common in some forms of cataract surgery than others. For example it is less likely to occur following extracapsular cataract extraction than after the clear corneal approach, where the incidence is around 0.75%.

Despite its relatively low incidence, endophthalmitis must be taken very seriously, as sudden and irreversible blindness or vision loss can result from this condition, he cautioned.


[Presentation title: Role of Systemic Antibiotics versus Intravitreal Antibiotics in Treatment of Endophthalmitis. Retina Sub-specialty Day]

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