J Korean Ophthalmol Soc.  2008 Apr;49(4):651-660. 10.3341/jkos.2008.49.4.651.

The Efficacy of Intravitreal Gatifloxacin in Experimental S. epidermidis Endophthalmitis

• Lee SY
• Ryu EH
• Moon SK
• Kim HJ
• Woo SY
• Cho MS
• Koh HJ

• KMID: 2211498
• DOI: http://doi.org/10.3341/jkos.2008.49.4.651

Abstract

PURPOSE: To compare the efficacy of intravitreal gatifloxacin with intravitreal vancomycin in the treatment of Staphylococcus epidermidis endophthalmitis in a rabbit model.
METHODS
Albino rabbits (n=30), infected with an intravitreal inoculum of S. epidermidis (10(5) colony forming unit/0.1 mL), were divided into 6 groups (n=5). Groups I and IV received 200 microgram/0.1 mL of intravitreal gatifloxacin, and groups II and V were injected 1000 microgram/0.1 mL of vancomycin intravitreally. Intravitreal balanced salt solutions (untreated control) were given to Groups III and VI. Intravitreal antibiotic therapy commenced 24 hours after bacterial inoculation. The bactericidal efficacy was determined by electroretinography (ERG), clinical grading, bacterial culture of vitreous aspirates and histopathologic grading. ERGs and clinical gradings were performed only for groups I, II, and III and bacterial cultures were done only for groups IV, V, and VI.
RESULTS
Eyes in the gatifloxacin groups showed similar appearance to those in the vancomycin treated groups clinically, histologically, and functionally as proved with ERG. All aspirates from the gatifloxacin and vancomycin groups were culture negative at 5 days after bacterial inoculation, whereas all eyes in the untreated control group were culture positive.
CONCLUSIONS
This study demonstrated that intravitreal injection of 200 microgram /0.1mL gatifloxacin appeared to be equally effective compared to intravitreal 1000 microgram /0.1 mL vancomycin in the treatment of S. epidermidis endophthalmitis. If proven safe and efficacious after further study in humans, intravitreal injection of gatifloxacin could be considered an effective alternative to vancomycin for the treatment of S. epidermidis endophthalmitis.

Keyword

Endophthalmitis; Gatifloxacin; Intravitreal antibiotics; Staphylococcus epidermidis; Vancomycin

MeSH Terms

Electroretinography
Endophthalmitis
Eye
Fluoroquinolones
Humans
Intravitreal Injections
Rabbits
Staphylococcus epidermidis
Vancomycin
Fluoroquinolones
Vancomycin

Figure

• 

  Figure 1. ERG responses obtained from eyes of groups I (A), II (B), and III (C). In each graph, the upper curves (wave 1) correspond to the ERG of experimental eyes and lower curves (wave 2) represent ERG from contralateral normal eyes. Baseline ERG before inoculation of S. epidermidis is on the left and the ERG of the same eyes 7 days after bacterial inoculation (6th day of antibiotics injection) is on the right. In gatifloxacin (A) and vancomycin (B) administered groups, the b‐ wave amplitude ratios (experimental/contralateral) are not changed, but b-wave implicit time ratios (experimental/contralateral) increase 7 days after bacterial inoculation. In infected control group (C), the wave of experimental eye is nearly extinguished. Short arrows, trough of a‐ waves; long arrows, peak of b-waves.

• 

  Figure 2. Histopathologic features of the retina, ciliary body, and vitreous in three eyes from each group (H & E). Gatifloxacin (A, group I) and vancomycin (B, group II) treated eyes shows relatively clear vitreous and well preserved retinal layers. In infected control group (C, group III), the retina, ciliary body, and vitreous are infiltrated with many inflammatory cells. Left column shows the retina, choroid, and sclera. ×200 (A and B), ×100 (C). Right column represents the ciliary body and vitreous base. ×40(A, B, and C). V, vitreous cavity; R, retina; C, choroids; S, sclera; CB, ciliary body.

• 

  Figure 3. Histopathologic features of the retina, ciliary body, and vitreous in groups 4 (A), 5 (B), and 6 (C) (H & E). Gatifloxacin (A, group IV) and vancomycin (B, group V) treated eyes show relatively clear vitreous and well preserved retinal layers. Some inflammatory cells are observed in the vitreous cavity. In untreated infected control group (C, group VI), the retina, ciliary body, and vitreous are infiltrated with dense inflammatory cells and no retinal layer is intact. Left column shows the retina, choroids, and sclera. ×200 (A and B), ×100 (C). Right column represents the ciliary body and vitreous base. ×40 (A, B, and C). V, vitreous cavity; R, retina; C, choroids; S, sclera; CB, ciliary body.

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