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First Author: A.Sergienko UKRAINE
Co Author(s): L. Lytvynchuk V. Serdiuk M. Havura
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To evaluate efficacy of intravitreal levofloxacin in treatment of exogenous and endogenous endophthalmitis of different etiology.
Kyiv Eye Microsurgery Center, Kyiv, Ukraine. Regional Ophthalmology University Clinic, Dnipropetrovsk, Ukraine
Thirty one patients with diagnosis of acute endophthalmitis were enrolled in the study. The mean age was 58 years (12 women, 19 men). In 27 patients exogenous endophthalmitis was diagnosed (18 after cataract surgery, 3 after intravitreal injection, 6 after penetrating eye injury) and in 4 patients - endogenous endophthalmitis was revealed. For intravitreal injection (IVI) 250mcg/0.1ml of levofloxacin (Santen, Oy.) was used in each case. Additional intracameral injection of 20 mcg of levofloxacin was administered after anterior chamber taping. Aqueous humor was exposed to microbiological examination. Patients were also treated with topical reinforced antibiotics and intravenous antibiotics. Clinical findings in conjunctiva, cornea, iris and vitreous body were classified according to grading scale of endophthalmitis severity (G.Payman, 2008) before and in 1 and in 10 days after intravitreal injection of levofloxacin.
Before treatment the mean total endophthalmitis severity score was 9.5. The mean values of ocular findings were following: conjunctiva 2.3, cornea 2.1, iris 2.4, vitreous body 2.8. In 19 patients visual acuity (VA) has ranged between light perception (LP) and hand motion (HM). In 12 patients VA ranged from 0.01 to 0.1. After IVI the mean total endophthalmitis severity score was 7, including: conjunctiva 1.5, cornea 1.8, iris 1.7, vitreous body 2.0. In 10 days after IVI the mean total endophthalmitis severity score was 5, including: conjunctiva 1.2, cornea 1.4, iris 1.2, vitreous body 1.4. In 8 cases IVI of levofloxacin was an addition to pars plana vitrectomy (PPV). Six patients underwent PPV next day after IVI. In 10 days after IVI: in 3 patients in spite of performed vitrectomy VA remained unchanged (LP); in 6 cases VA improved from LP to HM; in the rest 22 cases VA has ranged from 0.01 to 0.7. Microbiological assay has showed the following results: in 16 cases - S.epidermedis, in 8 cases S.aureus, in 3 cases - Seratia marcescens, in 4 cases bacteria wasnt discovered.
Intravitreal levofloxacin provides an activity against both Gram-positive and Gram-negative bacteria and seems to be an effective therapeutic option in treatment of exogenous end endogenous endophthalmitis with and without additional pars plana vitrectomy.