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. Method: 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 mu g of gentamicin sulfate and 45 mu g of clindamycin (cases) vs balanced salt solution (controls). Main Outcome Measure: 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. Conclusion: Intraocular gentamicin and clindamycin are effective in the prevention of acute posttraumatic bacterial endophthalmitis in eyes with retained intraocular foreign body. Application to Clinical Practice: Prophylaxis of traumatic endophthalmitis.