Aminoglycoside toxicity in the treatment of endophthalmitis. The Aminoglycoside Toxicity Study Group
P. A. Campochiaro and J. I. Lim
Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, Md.
OBJECTIVE AND METHODS: Intravitreous aminoglycosides are widely used for
the treatment and prophylaxis of endophthalmitis. Because the toxicity of
0.4 mg of gentamicin sulfate is well documented, many surgeons now use
amikacin sulfate or low-dose gentamicin to reduce the risk of macular
infarction. A survey of retinal specialists has suggested that amikacin or
low-dose gentamicin can also cause macular toxic side effects. To further
investigate this issue, the critical details of the case histories,
findings, and course of 13 patients who received intravitreous injections
of 0.2 to 0.4 mg of amikacin sulfate or 0.1 to 0.2 mg of gentamicin sulfate
for prophylaxis or treatment of endophthalmitis are summarized. For several
patients, complete case histories and a fluorescein angiogram are provided.
RESULTS: These cases suggest that amikacin and low-dose gentamicin, similar
to gentamicin sulfate at a dose of 0.4 mg, can cause macular infarction.
The causative dose cannot be ascertained in any of the cases, but doses
were prepared by hospital pharmacists using typewritten protocols, a
practice that helps to prevent dilution errors. Several of these cases
differ from previously reported cases of aminoglycoside toxicity in that
the involvement of the macula was quite discrete. Most of the patients
suffered severe visual loss, but two patients, in whom most of the
nonperfusion was adjacent to the macula and in whom some of the perifoveal
capillaries were spared, recovered 20/50 visual acuity. CONCLUSIONS: These
cases emphasize the potential hazards of the intravitreous use of
aminoglycosides. A toxic reaction can occur even when injection of low
doses is intended and precautions are made to avoid dilution errors. A
localized increase in concentration in dependent areas of the retina may
play a role in aminoglycoside toxicity. If some of the perifoveal
capillaries are spared, retention of some central vision is possible.
Consideration should be given to substituting ceftazidime for
aminoglycosides for the treatment and prophylaxis of endophthalmitis.
Prophylaxis for Posttraumatic Endophthalmitis
Essex et al.
Arch Ophthalmol 2008;126:742-743.
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Wiskur et al.
IOVS 2008;49:1480-1487.
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Hui et al.
Br. J. Ophthalmol. 2004;88:218-222.
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Kwok et al.
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Callegan et al.
Clin. Microbiol. Rev. 2002;15:111-124.
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Gan et al.
Br. J. Ophthalmol. 2001;85:1289-1293.
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LIFSHITZ et al.
Br. J. Ophthalmol. 2000;84:117a-117.
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Amikacin retinal toxicity
JACKSON and WILLIAMSON
Br. J. Ophthalmol. 1999;83:1194f-1194.
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SUNARIC-MEGEVAND and POURNARAS
Br. J. Ophthalmol. 1997;81:1006-1015.
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Assessment of a standard treatment protocol on visual outcome following presumed bacterial endophthalmitis
Okhravi et al.
Br. J. Ophthalmol. 1997;81:719-725.
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