Nontoxic Dose of Antimicrobials for Intravitreal Use in Endophthalmitis.

近年来，痤疮丙酸杆菌、耐甲氧西林表皮葡萄球菌、耐甲氧西林金黄色葡萄球菌和革兰氏阳性菌已成为增殖性糖尿病视网膜病变白内障囊外摘出合并后房型晶状体植入术或玻璃体切除术后细菌性眼内炎的重要病原菌。病毒性视网膜炎和内源性真菌性眼内炎的发病率随着免疫抑制治疗的使用而增加。因此，这些疾病的治疗现在非常重要。系统给药的抗菌素治疗往往不成功，因为它对眼睛的渗透能力差。因此，需要玻璃体内给药。本研究的目的是建立抗微生物药物的玻璃体内无毒剂量。采用玻璃体内注射或灌洗含抗菌剂溶液，通过视网膜电图、视觉诱发电位和组织学检查，研究了局部应用抗菌剂对兔视网膜的影响。我们还研究了手术条件下静脉注射氟莫西、洛美沙星、头孢他啶和氟康唑等抗菌剂的眼内渗透情况，以及单次玻璃体内注射氟莫西、洛美沙星、头孢他啶和BVaraU的眼内药代动力学。我们推荐临床使用的单针玻璃体内抗菌素剂量如下：氟莫塞200-400杯/0.1 ml，洛美福；200杯/0。1毫升，诺氟沙星50杯/0。1毫升，头孢他啶200-400mug/0。更昔洛韦100- 200马克杯/0.1毫升。我们建议玻璃体切除术时玻璃体内冲洗液的抗菌剂浓度为：氧氟沙星50马克杯/毫升，BVaraU 20马克杯/毫升。氟莫昔福头孢他啶在正常眼内静脉注射1小时后浓度较低，在玻璃体切除眼内即刻注射时浓度较高。正常眼和玻璃体切除眼的氯氟沙星浓度均较低。氟康唑-在正常眼和玻璃体切除眼中均有较高的眼内渗透。玻璃体切除术后氟康唑的眼内渗透没有增加。氟莫昔在玻璃体内的半衰期为4.4小时，洛美沙星为2.8小时，头孢他啶为7.4小时，B - VaraU为2.5小时。少

Recently, Propionibacterium acnes, methicfllin-resistant Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus and gram-positive organisms have become important pathogens in bacterial endophthalmitis after extracapsular cataract extraction with posterior chamber lens implantation or vitrectomy for proliferative diabetic retinopathy. The incidence of viral retinitis and endogenous fungal endophthalmitis has increased with use of immunosuppressive therapy. Therefore the treatment of these disorders is now very important. The treatment with systemically administered antimicrobials is often unsuccessful because of poor penetration into the eye. Therefore, intravitreal administration is needed. The purpose of the present research is to establish the nontoxic intravitreal dose of antimicrobials. Effects of topically applied antimicrobials on the retina were studied in rabbits with electroretinogram, visually evoked potential and histological examination after intravitreal i … More njections or irrigation of an antimicrobial-containing solution. We also studied the intraocular penetration of intravenously injected antimicrobials such as flomoxef, lomefloxacin, ceftazidime and fluconazole under surgical conditions, and intraocular pharmacokinetics of flomoxef, lomefloxacin, ceftazidime and BVaraU after a single intravitreal injection.Our recommended one-shot intravitreal dose of antimicrobials for clinical use is as follows : flomoxef 200-400 mug/0.1 ml, lomeflox ; acin 200 mug/0. I ml, norfloxacin 50 mug/0. I ml, ceftazidime 200-400mug/0. I ml and ganciclovir 100-200mug/0.1 ml. Our recommended concentration of antimicrobials for an intravitreal irrigation solution during vitrectomy is as follows : ofloxacin 50 mug/ml and BVaraU 20 mug/ml. The intravitreal flomoxef or ceftazidime concentration was low in nominal eyes one hour after intravenous injection, and high in vitrectomized eyes when injected immediately after surgery. The lorinefloxacin concentration was low in normal eyes and also in vitrectomized eyes. The high intraocular penetration of fluconazole-was observed in normal eyes as well as in vitrectomized eyes after intravenous administration. Intraocular penetration of fluconazole was not increased by vitrectomy. The half-life in the vitreous humor after intravitreal injection was 4.4 hours for flomoxef, 2.8 hours for lomefloxacin, 7.4 hours for ceftazidime and 2.5 hours for B VaraU. Less