Efficacy of Intravitreal Levofloxacin 0.5% Ophthalmic Solution in Treating Pseudomonas Aeruginosa Endophthalmitis on a Rabbit Model

ALTERNATIVE INTRAVITREAL ANTIBIOTICS: A Systematic Review for Consideration in Recalcitrant or Resistant Endophthalmitis

PURPOSE

To organize, categorize, and create a quick reference guide for the use of intravitreal antibiotic alternatives to the standard combination of vancomycin and ceftazidime for the treatment of endophthalmitis.

METHODS

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. The authors searched for all available information regarding intravitreal antibiotics in the last 21 years. Manuscripts were selected according to relevance, level of information, and the available data regarding intravitreal dose, potential adverse effects, bacterial coverage, and relevant pharmacokinetic information.

RESULTS

The authors included 164 of 1810 manuscripts. The antibiotics were classified according to their class into fluoroquinolones, cephalosporins, glycopeptide and lipopeptide, penicillins and beta-lactams, tetracyclines, and miscellaneous. The authors also included information regarding intravitreal adjuvants for the treatment of endophthalmitis and one ocular antiseptic.

CONCLUSION

The treatment of infectious endophthalmitis is a therapeutic challenge. The current review summarizes the properties of possible intravitreal antibiotic alternatives that should be considered in cases of suboptimal response to initial treatment.

Comparison of intravitreal antifungal 100 μg voriconazole and 5 μg amphotericin B in experimental <em>Aspergillus flavus</em> endophthalmitis model in rabbits

BACKGROUND Fungal endophthalmitis is a sight-threatening disease associated with high morbidity and Aspergillus sp. is the most common causes. Voriconazole (VCZ) and Amphotericin B (AmB) are the most used antifungal drugs, while head-to-head comparison for in vivo intravitreal efficacy is still unknown. This study was aimed to compare the efficacy of both agents against Aspergillus flavus.  METHODS A randomized, masked, controlled-experimental study was conducted on 15 albino New Zealand white rabbits. Endophthalmitis was induced by intravitreal inoculation of Aspergillus flavus. Intravitreal injection was given 24 hours post-inoculation, the rabbits were divided into three groups; 100 μg/0.1 ml VCZ intravitreal injection, 5 μg/0.1 ml AmB, and control. Clinical evaluation of corneal opacity, aqueous cells and flare, and vitreous opacity using Yang’s method of quantification were performed at day 1, 3, 5, 7, and 10 after treatment. Mycology quantitative analysis and histopathological examination were performed at the final evaluation.  RESULTS Clinical evaluation showed improvement of inflammation in the VCZ and AmB treatment groups (Δ score −2.1 [2.8] and −1.0 [3.2]) compared with the control group (Δ score 0.8 [3.1]). Although the VCZ group demonstrated a better clinical response with less inflammation and relatively intact retina structures in the histopathology result. Number of fungal colony was significantly less in AmB group (CFU/0.1 ml, p < 0.05).  CONCLUSIONS Favorable clinical improvement was shown in VCZ group compared to AmB group. Intravitreal VCZ showed a better clinical response tendency for Aspergillus flavus-induced endophthalmitis in rabbits.