Aminoglycoside toxicity--a survey of retinal specialists. Implications for ocular use
P. A. Campochiaro and B. P. Conway
Department of Ophthalmology, University of Virginia Health Sciences Center, Charlottesville 22908.
Surveyed members of the Retina, Macula, and Vitreous Societies reported 93
cases of macular infarction they believed to be related to administration
of gentamicin sulfate; five, to administration of amikacin sulfate; and
three, to administration of tobramycin sulfate. Most cases of infarction
after administration of gentamicin occurred in eyes that received an
intravitreous injection of 0.4 mg after vitrectomy, but a surprisingly high
number, 17, occurred after injection of 0.1 or 0.2 mg, doses that are
considered safe by many ophthalmologists. Four additional cases of
infarction occurred in eyes that did not undergo vitrectomy after injection
of 0.1 or 0.2 mg. Four of the five cases related to administration of
amikacin occurred after intravitreous injection of 0.4 mg, and one of these
four occurred in an eye that did not undergo vitrectomy. Twenty-three cases
of macular infarction occurred in eyes that were treated with prophylactic
subconjunctival injections of aminoglycosides after routine ocular surgery.
Responses from this survey suggest that aminoglycoside-induced retinal
infarction is widely recognized and more common than indicated from the
small number of cases reported in the literature. The role of
aminoglycosides in the prophylaxis of ocular infections and the management
of endophthalmitis should be reevaluated.
