Prophylaxis of acute posttraumatic bacterial endophthalmitis: a multicenter, randomized clinical trial of intraocular antibiotic injection, report 2.
OBJECTIVE
To evaluate the efficacy of intraocular gentamicin sulfate and clindamycin in the prevention of acute posttraumatic bacterial endophthalmitis following penetrating eye injuries.


METHODS
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).


METHODS
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.


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


CONCLUSIONS
Prophylaxis of traumatic endophthalmitis.


BACKGROUND
clinicaltrials.gov Identifier: NCT00398658.
Soheilian
Masoud
M
Department of Ophthalmology and Ophthalmic Research Center, Labbafinejad Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. masoud_soheilian@yahoo.com
Rafati
Nasrin
N
Mohebbi
Mohammad-Reza
MR
Yazdani
Shahin
S
Habibabadi
Houshang Faghihi
HF
Feghhi
Mostafa
M
Shahriary
Hossein A
HA
Eslamipour
Jamil
J
Piri
Niloofar
N
Peyman
Gholam A
GA
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002981:Clindamycin / Q000627:therapeutic use; D004311:Double-Blind Method; D009877:Endophthalmitis / Q000382:microbiology / Q000517:prevention & control*; D005129:Eye Foreign Bodies / Q000150:complications; D015818:Eye Infections, Bacterial / Q000382:microbiology / Q000517:prevention & control*; D015807:Eye Injuries, Penetrating / Q000150:complications*; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D007267:Injections; D008297:Male; D011183:Postoperative Complications; D014822:Vitreous Body / Q000382:microbiology
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D002981:Clindamycin