Masoud Soheilian, MD (Tehran, Iran), Nasrin Rafati, MD (Tehran, Iran), Shahin Yazdani, MD (Tehran, Iran), Houshang Faghihi  Habibabadi, MD (Tehran, Iran), Mostafa Feghhi, MD (Tehran, Iran), Hossein A Shahriari, MD (Tehran, Iran), Mohammad Reza Mohebi, MD (Tehran, Iran), Niloufar Piri, MD (Tehran, Iran), Gholam A. Peyman, MD (New Orleans, LA)

PURPOSE:

To evaluate the efficacy of combined intraocular injection of gentamicin and clindamycin in prevention of acute posttraumatic bacterial endophthalmitis (APBE) following penetrating eye injuries.

DESIGN:

Multicenter, randomized, double masked, controlled trial. Participants: 346 eyes of 346 patients with penetrating eye injury. Method: Following primary repair, eyes were randomized to receive a 0.1 ml intracameral or intravitreal injection of 40 μg gentamicin and 45 μg clindamycin (cases), versus intracameral or intravitreal injection of 0.1ml balanced saline solution (controls). All patients received standard prophylactic antibiotic therapy (systemic, subconjunctival and topical). Main outcome measures: Occurrence of endophthalmitis within two weeks after primary repair.

RESULTS:

The overall incidence of acute posttraumatic bacterial endophthalmitis was 2.6% (9 eyes). Endophthalmitis occurred in 8 of 167 eyes in the control group (2.3%) and only in one of 179 eyes in the case group (0.3%) [p<0.04]. Odds ratio of developing endophthalmitis was 8.93 times higher in controls (95% CI, 1.11-71.43). Retained intraocular foreign body (IOFB) was
present in 52 eyes (including 25 and 27 eyes in controls and cases respectively). Endophthalmitis developed in 7 of 52 eyes (13%) with retained IOFB and in 2 of 294 eyes (0.6%) without an IOFB (p<0.039). Vitreous culture was positive in 6 of 9 eyes (66.6%) with endophthalmitis; the most common isolated microorganism was Staphylococcus epidermis.

CONCLUSION:

Intraocular injection of gentamicin and clindamycin in addition to other methods of prophylaxis is effective in prevention of acute posttraumatic bacterial endophthalmitis even in high-risk cases such as those with retained IOFB. These antibiotics have a major role as adjuncts to primary repair of eyes with penetrating injury without significant side effects at the dosage used.