Results in the Treatment of Postoperative Endophthalmitis

Olson, John C.; Flynn, Harry W.; Forster, Richard K.; Culbertson, William W.

doi:10.1016/s0161-6420(83)34511-5

Cited by 162 publications

(63 citation statements)

References 13 publications

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“…aureus is a leading cause of post-traumatic and postoperative endophthalmitis. Like E. faecalis and B. cereus, the clinical outcome of S. aureus endophthalmitis is frequently poor, resulting in visual outcomes with final visual acuities of 20/400 or worse in more than 50% of reported cases (3,68,99,103,110,121). The increased incidence of multiple antibiotic resistance in clinical isolates threatens to further increase the rate of treatment failures for S. aureus.…”

Section: S Aureus Global Regulation and Toxinsmentioning

confidence: 99%

Bacterial Endophthalmitis: Epidemiology, Therapeutics, and Bacterium-Host Interactions

et al. 2002

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SUMMARY Endophthalmitis is a severe inflammation of the interior of the eye caused by the introduction of contaminating microorganisms following trauma, surgery, or hematogenous spread from a distant infection site. Despite appropriate therapeutic intervention, bacterial endophthalmitis frequently results in visual loss, if not loss of the eye itself. Although the pathogenicity of bacterial endophthalmitis has historically been linked with toxin production during infection, a paucity of information exists as to the exact mechanisms of retinal toxicity and the triggers for induction of the intraocular immune response. Recently, research has begun to examine the bacterial and host molecular and cellular events that contribute to ocular damage during endophthalmitis. This review focuses on the causative agents and therapeutic challenges of bacterial endophthalmitis and provides current data from the analysis of the role of bacterial virulence factors and host inflammatory interactions in the pathogenesis of eye infections. Based on these and related studies, a hypothetical model for the molecular pathogenesis of bacterial endopthalmitis is proposed. Identifying and understanding the basic mechanisms of these bacterium-host interactions will provide the foundation for which novel, information-based therapeutic agents are developed in order to prevent vision loss during endophthalmitis.

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Section: S Aureus Global Regulation and Toxinsmentioning

confidence: 99%

Bacterial Endophthalmitis: Epidemiology, Therapeutics, and Bacterium-Host Interactions

et al. 2002

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“…Bacterial endophthalmitis is a severe, sight-threatening infection which most commonly occurs after cataract surgery (10,32). The current therapy of bacterial endophthalmitis includes the intraocular and systemic administration of antibiotics combined with a pars plana vitrectomy (9,10,32,34,35).…”

mentioning

confidence: 99%

“…The current therapy of bacterial endophthalmitis includes the intraocular and systemic administration of antibiotics combined with a pars plana vitrectomy (9,10,32,34,35). The National Eye Institute Endophthalmitis Vitrectomy Study (EVS) is currently evaluating the relative impact of vitrectomy and systemic antibiotics on the outcome of patients receiving intraocular antibiotics.…”

mentioning

confidence: 99%

Pharmacokinetics of ofloxacin in serum and vitreous humor of albino and pigmented rabbits

Perkins

Liu

Drusano

et al. 1995

Antimicrob Agents Chemother

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The purpose of this study was to evaluate the pharmacokinetics of ofloxacin in serum and vitreous humor samples from albino and pigmented rabbits by using a recently described animal model which permits robust estimation of parameter values. The drug was administered to rabbits intravenously, multiple vitreous humor and serum samples were taken from each rabbit, and the vitreous humor and serum samples were assayed by high-pressure liquid chromatography. The pharmacokinetic parameters were determined with RSTRIP, an iterative, nonlinear, weighted, least-squares regression program. Eight New Zealand White rabbits and eight Dutch Belted rabbits (split into single-dose and multiple-dose groups) were investigated in this study. The value of penetration into the vitreous humor of albino rabbits (n ‫؍‬ 6) was 32.6% ؎ 2.12%, with terminalelimination half-life values of 3.21 and 2.39 h, respectively, for vitreous humor and serum. In pigmented rabbits after a single dose (n ‫؍‬ 3) and with a steady-state concentration of drug in serum (n ‫؍‬ 4), penetration values were similar, at 30.4% ؎ 2.98% and 30.0% ؎ 4.12%, respectively (P > 0.10). Following a single dose of ofloxacin, pigmented animals had elimination half-life values from serum and vitreous humor of 2.64 and 4.32 h, respectively. After steady state was achieved, half-life values for serum and vitreous humor were 3.12 and 6.05 h, respectively. By comparing pigmentation, dose mode, and elimination from vitreous humor, the vitreous humor half-life value for singly dosed albino rabbits (3.21 h) was not more rapid than that for singly dosed pigmented rabbits (4.32 h [P > 0.10]) but was more rapid than that for multiply dosed pigmented rabbits (6.05 h [P < 0.05]). The excellent penetration of ofloxacin into uninflamed rabbit eyes in conjunction with the higher levels in blood found in humans and greater activity against coagulase-negative staphylococci suggest that ofloxacin may be preferable to other quinolones for evaluation in the prophylaxis and treatment of bacterial endophthalmitis.We have recently developed and validated an ocular pharmacokinetic animal model which differs from conventional methods that obtain a single sample of vitreous humor from different animals (20,25,26,29). In our model, serial samples are obtained from the vitreous humor after intravenous drug administration. This model does not alter the pharmacokinetics of drugs in the eye (24,25,29). Serial sampling is preferable, since it permits more-rigorous pharmacokinetic analysis and decreases the number of animals which are needed for the same degree of certainty in the pharmacokinetics parameter estimates by more than 50-fold compared with the single-sample approach (20).Bacterial endophthalmitis is a severe, sight-threatening infection which most commonly occurs after cataract surgery (10, 32). The current therapy of bacterial endophthalmitis includes the intraocular and systemic administration of antibiotics combined with a pars plana vitrectomy (9,10,32,34,35). The National Eye Institute En...

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“…Inflammation and the achievement of a steady state in serum both appear to increase drug penetration into the vitreous humor (23). New investigational quinolones have excellent activity against the gram-positive pathogens (19,26,32,35) that are most commonly isolated in bacterial endophthalmitis (11,25,29). These observations, in conjunction with results of our pharmacokinetic studies, suggest that the fluoroquinolone antimicrobial agents may have a role in the prophylaxis and therapy of bacterial endophthalmitis.…”

Section: Discussionmentioning

confidence: 59%

“…The intraocular delivery and maintenance of therapeutic levels of antimicrobial agents into the eye, particularly the vitreous humor, continue to be vexing problems. Although intraocular drug administration in conjunction with vitrectomy preserves sight in many patients (3,10,11,25,29), this therapy is not successful in all patients. Intraocular drug administration can cause retinal damage (9,27).…”

mentioning

confidence: 99%

Fleroxacin pharmacokinetics in aqueous and vitreous humors determined by using complete concentration-time data from individual rabbits

Miller

Madu

Samathanam

et al. 1992

Antimicrob Agents Chemother

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Although composite data from separate subjects can be used to generate single-subject estimates, intersubject variation precludes rigorous ocular pharmacokinetic analysis. Therefore, a rabbit model in which sequential aqueous and vitreous humor samples were obtained following the administration of the quinolone fleroxacin was developed. Mean data from individual animals were used for pharmacokinetic analysis. Following direct intravitreal or systemic drug administration, sequential paracenteses did not alter pharmacokinetic constants or ocular penetration and were not associated with an increase in ocular protein; contamination of vitreous humor with blood was minimal (<0.1%). Following direct injection or intravenous administration, vitreous humor concentration-time data were best described by one-and two-compartment models, respectively. The maximum concentration and the penetration into the aqueous and vitreous humors were 1.54 and 0.5 ,ug/ml and 27 and 10%, respectively. Elimination rates from aqueous and vitreous humors and serum were similar following parenteral drug administration. Drug elimination following direct injection was rapid, and the elimination rate from the vitreous humor was not prolonged by the coadministration of probenecid. Our animal model provides a new approach to the rigorous examination of the ocular pharmacokinetics of quinolone antimicrobial agents in the eye.

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Results in the Treatment of Postoperative Endophthalmitis

Cited by 162 publications

References 13 publications

Bacterial Endophthalmitis: Epidemiology, Therapeutics, and Bacterium-Host Interactions

Bacterial Endophthalmitis: Epidemiology, Therapeutics, and Bacterium-Host Interactions

Pharmacokinetics of ofloxacin in serum and vitreous humor of albino and pigmented rabbits

Fleroxacin pharmacokinetics in aqueous and vitreous humors determined by using complete concentration-time data from individual rabbits

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