Endophtalmie : étiopathogénie et antibioprophylaxie

[Rational approach for the treatment of postoperative endophthalmitis in impoverished populations]

Due to the need for treatment guidelines for endophthalmitis in impoverished areas, we have formulated an approach which takes into account pharmacokinetic data, keeping in mind that, whether oral or intramuscular, antibiotics must achieve therapeutic intraocular levels, antibiotic susceptibility of the most common pathogens in endophthalmitis, and routine availability of bioequivalent generics in the areas in question. In this work, we present the basic guidelines for the management of postoperative endophthalmitis by ophthalmology services in impoverished areas.

A European perspective on topical ophthalmic antibiotics: current and evolving options

BACKGROUND

Eye infections can be vision-threatening and must be treated effectively by appropriate and safe use of topical ophthalmic anti-infectives. This review will essentially consider the current and evolving treatment options for the various types of bacterial eye infections. Ocular surface bacterial infections affect subjects of all ages with a high frequency in newborns and children.

METHODS

This article presents a review of the peer-reviewed published scientific literature in order to define the well-established uses of anti-infective eye drops in the field of ocular infections. A comprehensive search of the recent published literature including topical ophthalmic anti-infectives effective in bacterial ocular infections was performed. Clinical studies provide relevant data concerning the characteristics and clinical efficacy of antibacterial eye drops in ocular anterior segment infections or for perioperative prophylaxis. Publications were included to cover the current options of antibacterial eye drops available in Europe.

RESULTS

Several recent publications identified effective topical ocular antibacterials requiring a reduced dose regimen and a short treatment course. Additional literature reviewed included data on novel perioperative prophylaxis, indications for topical fortified antibiotics and innovative research including the risk of resistance.

CONCLUSIONS

Safe and effective topical antibiotic eye drops for the treatment and prevention of ocular infections must be adapted to the type of bacteria suspected. Usual topical antimicrobials should be replaced by more recent and more effective treatments. The use of highly effective fluoroquinolones should be reserved for the most severe cases to avoid resistance. Short treatment courses, such as azithromycin, can be easily used in children, thereby improving quality of life.

[Eye infections associated with ocular implants]

Postoperative endophthalmitis associated with intraocular lens implantation is one of the most severe complications of cataract surgery. The prevalence of endophthalmitis following these procedures reported in several multicenter studies over the last decades is 0.05% to 0.32%. Currently, general consensus measures are available to prevent this serious complication. Abiotic biofilm formation with adhesion of pathogens on the surface of intraocular devices is a novel theory that is little understood, but widely accepted to explain the pathophysiologic aspects of intraocular infection. Bacterial adhesion on intraocular lenses has been observed in clinical practice and investigated with several in vitro approaches in various experimental conditions. Improvements in the surgical techniques used in cataract surgery and the advent of new antimicrobial agents with a wider spectrum of action and better penetration in the eye, have resulted in significant advances in the prevention and treatment of intraocular implant-related infection.