| Objective : Commonly used in clinical treatment of bacterial endophthalmitis intravitreal injection method combined ceftazidime vancomycin. Vancomycin for the clinical treatment of bacterial endophthalmitis first-line drugs, he is a narrow-spectrum bactericidal antibiotics, Gram-positive bacteria only have a strong bactericidal effect, so often, and gram negative bacilli in combination therapy of ceftazidime eye Endophthalmitis. In recent years, the increasing resistance of bacteria into the clinical treatment of infectious endophthalmitis problem, any Zhe et al. found that gram-positive bacteria sensitive to vancomycin decreased, down 84.4% from 100.0%; addition Research has shown that vancomycin against coagulase-negative staphylococci (Staphylococcus epidermidis, Staphylococcus haemolyticus, Staphylococcus and other people) less sensitive. Research data in China in 2005 methicillin-resistant Staphylococcus aureus (MRSA) incidence rate has reached 51.3%, while Shanghai is as high as 78.4%. Staphylococcus epidermidis, Staphylococcus haemolyticus resistant strains also showed rapid growth trend and the high diversity of vancomycin resistance. This sounded the alarm for our clinical medicine. ceftazidime is the third generation cephalosporins, vancomycin in combination with his play against the major role of Gram-negative bacteria (Pseudomonas aeruginosa). ceftazidime with the clinical use of drugs High-dose, long time, and medication was not standardized, Gram-negative bacilli to ceftazidime resistance increased year by year: 2000 Pseudomonas aeruginosa to ceftazidime resistance rate is 14% .in 2006 of Pseudomonas aeruginosa to ceftazidime resistance as high as 60%.Isepamicin sulfate as a new generation of aminoglycoside antibiotic with a broad spectrum antimicrobial, bactericidal activity, and drug resistance is low, drug side effects and good after-effects of antibiotics and other advantages. It has been widely used to treat serious infectious diseases and mixed infections. Isepamicin bacterial endophthalmitis on the main pathogen Staphylococcus epidermidis, Staphylococcus aureus and Pseudomonas aeruginosa and other pathogens in vitro antibacterial activity of strong. However, no reports of intraocular drug. This study was to observe the animal experiments isepamicin sulfate injection after intravitreal retinal toxicity, for clinical intraocular medication to provide the basis.Methods:1 Free eye screening healthy 24 adult New Zealand white rabbits, regular feeding week2 Preoperative routine measure and record the electrophysiology of each rabbit eye: full-field electroretinogram(FERG) examine. suggests mixed reactions (Max-R) of the b wave amplitude.3 The 24 rabbits were randomly divided into A, B, C, D four groups, and each group only 6. Isepamicin sulfate were diluted with saline containing 0.5,1.0,2.0,4.0 mg 0.1ml liquid reserve of isepamicin. Of a randomly selected for the experiment each rabbit eyes were injected with 0.1ml vitreous body with different concentrations of drugs. Contralateral eye as control eyes were injected in the vitreous 0.1ml saline4 After 1 day, 3 days, 7 days, 14 days observed in the anterior segment of each rabbit and fundus situation and record the results. Two rabbits in each group were randomly selected review FERG. In each group at each time point whether the difference between the value of electrophysiological and preoperative values at different time points after the changes, the results were analyzed.5 3,7,14 days after surgery in each group were randomly taken from two rabbits (in this case has done Electrophysiology), the removal of the eye, The two eyes of each rabbit into a 10% formalin fixed, 48 h after the conventional dehydration, paraffin embedding, paraffin sections made, to do HE staining to observe the general morphology of retinal. The other eye of each rabbit immediately placed in 4℃, 2.5% glutaraldehyde solution in the fixed transmission electron microscope images made to observe the ultrastructure changes.Results:1 Slit lamp examination: In 0.5mg, 1.0mg, 2.0mg, 4.0mg four groups in addition to the 0.5mg group, two eyes due to technical reasons injection, drug injection in the vitreous cavity when the damage the crystal, the first day after injection, there was vitreous opacity. The other groups had no corneal edema, opacity, Descemet folds free; anterior chamber without bleeding, exudation inflammation; lens opacity-free; vitreous without muddy, bleeding.2 Direct ophthalmoscopy: 0.5mg, 1.0mg, 2.0mg, 4.0mg in each group had no vitreous opacity, hemorrhage, no retinal edema, hemorrhage, detachment, retinal blood vessels were not occluded, tortuous, expansion. After intravitreal injection of each group slightly turbid, disappeared after a day. D group (4mg group) one eye on the first day after injection of local retinal edema, edema and significantly reduced on day 3, day 14 edema disappeared, and the remaining non-exception.3 ERG examination: Max-R b wave amplitude (see table) among the four groups on the whole, significant differences (P <0.05), where C set of experiments focus on the 3 days after injection, the amplitude decreased significantly, 14 days Shiyou back to normal; D experiments 3-7 days after injection, the eye amplitude decreased significantly lower than the control eyes, and the control eyes were significantly different (P <0.05). the other two experimental groups at each time B wave amplitude and the control eyes was no significant difference in the eye4 light microscope: the control group and each dosage group at all time periods were normal retinal structure.5 electron microscope: A, B group and C, D groups of the control eyes, the time structure of the normal retinal layers. C. D group in different time abnormality as follows: C group (2.0mg) 3-7 days pigment epithelium shows mild swelling of mitochondria, pigment epithelium 14 days of shows mitochondrial swelling disappeared; D group (4., 0mg) 3 days, the pigment Mild swelling of mitochondria in the epithelium, showing large lysosomes, 7 days pigment epithelium mitochondria swelling, crest disappeared. Pigment epithelial cells for 14 days with moderate swelling of mitochondria, outer segment membrane disc disorders, outside from the state layer, inner nuclear layer, ganglion cells with moderate edema, nerve fiber layer edema.Conclusion: 1.0mg dose of isepamicin sulfate the following intravitreal injection is safe. 2.0mg dose of intravitreal injection in rabbit eyes can cause irreversible damage in rabbit retina.
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