Prophylaxis of acute posttraumatic bacterial endophthalmitis with or without combined intraocular antibiotics: a prospective, double-masked randomized pilot study.
OBJECTIVE
The effectiveness of an intraocular injection of combined gentamicin and clindamycin in the prevention of acute posttraumatic bacterial endophthalmitis following penetrating ocular injuries was evaluated in a prospective, double-masked, randomized pilot study.


METHODS
Sixty eyes of 60 patients with penetrating ocular injuries were treated at a tertiary care hospital. Following primary repair, the eyes were randomized in two groups. Group 1, the antibiotic injection group (cases), was given an intracameral or intravitreal injection of 0.1 mL antibiotic (40 microg gentamicin and 45 microg clindamycin). Group 2 (balanced saline solution [BSS] injection group [controls]) received intracameral or intravitreal injection of 0.1 mL BSS. All patients received standard prophylactic antibiotic therapy (systemic, subconjunctival, and topical).


RESULTS
Although the overall incidence of acute posttraumatic bacterial endophthalmitis was 6.6% (4 eyes), the results of three cultures were negative. All endophthalmitis cases occurred in the BSS injection group; however, there was no statistically significant difference between case and control groups (p = 0.11). The incidence rate for those with retained intraocular foreign bodies was 13.3% and for those without foreign bodies was 4.4%. No retinal toxicity was detected.


CONCLUSIONS
Intraocular injection of gentamicin and clindamycin in addition to the other methods of prophylaxis may be an effective modality in the prevention of posttraumatic endophthalmitis. Early results suggest that these antibiotics may have a role as adjunct therapy to primary repair of injured globes without significant side effects at the dosage used.
Soheilian
M
M
Ophthalmology Department, Shahid Beheshti University of Medical Sciences, Labbafinejad Medical Center, Tehran, Iran. labbafi@hotmail.com
Rafati
N
N
Peyman
G A
GA
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000008:administration & dosage*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D009877:Endophthalmitis / Q000209:etiology / Q000382:microbiology*; D005123:Eye; D005129:Eye Foreign Bodies / Q000150:complications; D015818:Eye Infections, Bacterial / Q000453:epidemiology / Q000517:prevention & control*; D005131:Eye Injuries / Q000188:drug therapy*; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D007267:Injections; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012965:Sodium Chloride / Q000008:administration & dosage; D014822:Vitreous Body; D014950:Wounds, Penetrating / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D002981:Clindamycin; D012965:Sodium Chloride