Prophylaxis of acute posttraumatic bacterial endophthalmitis: a multicenter, randomized clinical trial of intraocular antibiotic injection, report 2.

Abstract

OBJECTIVE:

To evaluate the efficacy of intraocular gentamicin sulfate and clindamycin in the prevention of acute posttraumatic bacterial endophthalmitis following penetrating eye injuries.

METHOD:

We conducted a multicenter, randomized, double-masked controlled trial of 346 eyes with penetrating eye injury. Following primary repair, eyes were randomized to intracameral or intravitreal injection of 40 microg of gentamicin sulfate and 45 microg of clindamycin (cases) vs balanced salt solution (controls).

MAIN OUTCOME MEASURE:

Occurrence of endophthalmitis within 2 weeks.

RESULTS:

Endophthalmitis occurred in 8 (2.3%) of 167 eyes in the control group and only in 1 (0.3%) of 179 eyes in the case group (P = .04; odds ratio, 8.93 [95% confidence interval, 1.11-71.43]). In eyes with an intraocular foreign body, endophthalmitis developed in 7 of 25 control eyes and in none of 27 eyes receiving antibiotics. However, in eyes without an intraocular foreign body, endophthalmitis developed in 1 of 142 eyes and 1 of 152 eyes in the 2 groups, respectively (P value for interaction = .04). Intravitreal injection was superior to intracameral injection in preventing endophthalmitis (P value for interaction = .01). Vitreous culture results were positive in 6 (67%) of 9 eyes with endophthalmitis.

CONCLUSION:

Intraocular gentamicin and clindamycin are effective in the prevention of acute posttraumatic bacterial endophthalmitis in eyes with retained intraocular foreign body.

APPLICATION TO CLINICAL PRACTICE:

Prophylaxis of traumatic endophthalmitis.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT00398658.

• Authors: Masoud Soheilian, Nasrin Rafati, Mohammad-Reza Mohebbi, Shahin Yazdani, Houshang Faghihi Habibabadi, Mostafa Feghhi, Hossein A Shahriary, Jamil Eslamipour, Niloofar Piri, Gholam A Peyman, Traumatic Endophthalmitis Trial Research Group
• Journal: Archives of ophthalmology (Chicago, Ill. : 1960) (Arch Ophthalmol) Vol. 125 Issue 4 Pg. 460-5 (Apr 2007) ISSN: 0003-9950 [Print] United States
• PMID: 17420365 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Gentamicins
• Clindamycin

Topics

• Anti-Bacterial Agents (therapeutic use)
• Antibiotic Prophylaxis
• Clindamycin (therapeutic use)
• Double-Blind Method
• Endophthalmitis (microbiology, prevention & control)
• Eye Foreign Bodies (complications)
• Eye Infections, Bacterial (microbiology, prevention & control)
• Eye Injuries, Penetrating (complications)
• Female
• Gentamicins (therapeutic use)
• Humans
• Injections
• Male
• Postoperative Complications
• Vitreous Body (microbiology)