Treatment of Experimental Methicillin-Resistant Staphylococcus epidermidis Endophthalmitis with Intravitreal Vancomycin and Intravitreal Dexamethasone

Abstract

The use of intravitreal steroids to treat bacterial endophthalmitis remains controversial. The efficacy of intravitreal vancomycin alone (group 1), intravitreal dexamethasone alone (group 2), and a combination of intravitreal vancomycin and dexamethasone (group 3) in the treatment of experimental methicillin-resistant Staphylococcus epidermidis endophthalmitis was evaluated in a rabbit model: 24 h after bacterial inoculation of all eyes, right eyes were treated and left eyes served as infected controls. Vitreal aspirations and grading of vitreal inflammatory reaction were done regularly until sacrifice. Group 2 eyes demonstrated more inflammation histologically than control eyes. Vitreal aspirations demonstrated no growth by 5 days from groups 1 and 3 eyes. Although the clinical appearance was not significantly different between groups 1 and 3, the histologic appearance of group 3 eyes showed less intense intraocular inflammation. Treatment with dexamethasone in the absence of appropriate antibiotics was more harmful than no treatment at all (P < .05). Therapy with both intravitreal vancomycin and dexamethasone results in less inflammation than intravitreal vancomycin alone in this model.

Bacterial endophthalmitis: Therapeutic challenges and host–pathogen interactions

“…The use of steroids in the treatment of endophthalmitis has been controversial and there remains no clear evidence of their benefit for this disease. Experimental models and clinical studies have reported that concomitant administration of dexamethasone with antibiotics were detrimental , beneficial (Gan, et al, 2005;Liu, et al, 2000;Smith, et al, 1997;Yildirim, et al, 2002) or had no effect Ermis, et al, 2005;Pollack, et al, 2004;Shah, et al, 2000). Despite the controversy, dexamethasone is frequently used as an adjunct to antibiotics for the treatment of endophthalmitis.…”

Susceptibilities of Propionibacterium acnes Ophthalmic Isolates to Ertapenem, Meropenem, and Cefepime

“…Direct intravitreal antibiotic instillation has been shown to be safe and effective for the treatment of many aerobic organisms (8,9,11). Optimal treatment of P. acnes, which has been shown to cause a chronic, indolent infection after cataract surgery and lens implantation despite intravitreal vancomycin instillation, vitrectomy, and removal and exchange of the intraocular lens, remains unknown (2, 4).…”

Efeito terapêutico da aplicação intra-ocular de ozônio em modelo experimental de endoftalmite por Staphylococcus epidermidis em coelhos

“…Seu tratamento depende de diagnóstico preciso e precoce e oferece diferentes abordagens que visam a eliminação da bactéria e a diminuição da reação inflamatória desencadeada pela infecção. As opções de tratamento atualmente são a utilização de combinações de antimicrobianos de amplo espectro administrados por várias vias associados com corticóides ou vitrectomia terapêutica (6) . A escolha de um destes métodos é controverso, já que seus resultados são muito variáveis devido à virulência dos organismos e à resposta individual ao tratamento.…”

“…A escolha de um destes métodos é controverso, já que seus resultados são muito variáveis devido à virulência dos organismos e à resposta individual ao tratamento. A escolha de terapia mais agressiva, em alguns casos, não é suficiente para impedir o processo de destruição celular do olho (5)(6) . Ozônio é utilizado para esterilização de materiais em grande volume de forma eficaz.…”