The authors declare no conflict of interest.

Purpose:

To report the efficacy of intravitreal levofloxacin as an initial treatment of acute exogenous endophthalmitis on the stage of transportation of the patients to the vitreoretinal department and before early pars plana vitrectomy (PPV).

Methods:

Thirty patients (34 eyes) with exogenous endophthalmitis were included to this prospective non-randomized study. Fourteen patients (41.2%) had posttraumatic, and 20 patients (58.8%) postoperative endophthalmitis, respectively. Standard ophthalmological examinations were performed before IVI, before PPV and after PPV. The severity of endophthalmitis was classified according to Endophthalmitis Severity Score by Peyman and all (2008) before IVI and before PPV. After the diagnosis was made in non-surgical eye departments, all the patients underwent immediate intravitreal injection (IVI) of Levofloxacine 200 mcg/0.01 ml OFTAQUIX, Santen Oy, Tempere, Finland, EU). After the IVI, the patients were referred to vitreoretinal department at Kyiv Eye Microsurgery Center. Early PPV was performed in every case within 3-24 hours after the initial diagnosis. The vitreous specimens were taken for microbiological assay and antibiotic Sensitivity analysis in every patient.

Results:

The mean initial BCVA was light perception. The mean BCVA at the first day after PPV was 0.17. The mean Endophthalmitis Severity Score (ESS) before the IVI was 8.5. The mean ESS at the admission in vitreoretinal department and before PPV was 5.1. PPV was enabled by the increased transparency of the cornea and anterior chamber after IVI. Microbiological assay showed the presence of Staphylococus epidermidis in 22 cases (64.7%), Streptococus aureus in 10 cases (29.4%), and Serratia in 2 cases (5.9%). In 27 (79.4%) cases the bacteria was susceptible to Levofloxacine, and in 7 (20.6%) cases the antibiotic Sensitivity test showed intermediate susceptibility to Levofloxacine.

Conclusions:

The use of intravitreal injection of Levofloxacine 200 mcg/0.01 in patients with exogenous endophthalmitis caused by Gramm-positive and Gram-negative bacteria can prevent the exacerbation of the inflammatory reaction on the stage when the patient has been transported to the vitreoretinal department. The partial clearance of the cornea and anterior chamber of the eye after the IVI of Levofloxacine can provide a better visualization of the posterior segment of the eye during early PPV.

Contact Details:

Email: amsergienko@ukr.net
Cell Phone: +380672324646