Fluoroquinolone Antibiotic Prophylaxis to Prevent Post-Traumatic Bacterial Infectious Endophthalmitis: Using Monte Carlo Simulation to Evaluate the Probability of Success.

Purpose: Patients with open globe injuries routinely receive fluoroquinolone (FQ) prophylaxis to prevent bacterial infectious endophthalmitis. Owing to the rarity of this infection, there is an absence of clinical trials evaluating optimal prophylactic FQ dosing. To address this knowledge gap, we conducted a Monte Carlo simulation (MCS)-based study to identify the FQ dosing option(s) that optimize pharmacokinetic-pharmacodynamic FQ target attainment against common bacterial pathogens implicated in post-traumatic bacterial infectious endophthalmitis (PTBIE). Methods: Weighted mean pharmacokinetic parameters and standard deviations for ciprofloxacin, levofloxacin, and moxifloxacin were calculated from published studies in healthy volunteers. The incidence and FQ susceptibility profiles for the most common bacteria causing PTBIE were extracted from the literature. MCS was used to determine the cumulative fraction of response (CFR) for 5 FQ dosing options to determine the probability of attaining pathogen-specific target 24-hour area under the curve to minimum inhibitory concentration ratios in the vitreous humor of the eye against the 4 most common causative bacteria seen in PTBIE. Results: Moxifloxacin 400 mg po daily (M400) achieved the highest CFR (72%). Levofloxacin dosing options achieved CFRs between 54% and 63%. Ciprofloxacin dosing options achieved CFRs between 28% and 35%. Conclusion: M400 optimized the likelihood of prophylactic success in the prevention of PTBIE, and based on the study findings, M400 is predicted to optimize the probability of success compared with ciprofloxacin and levofloxacin dosing options currently endorsed by expert opinion.

Posttraumatic Endophthalmitis in children: Epidemiology, Diagnosis, Management, and Prognosis.

Pediatric posttraumatic endophthalmitis presents with great complexities and challenges arising due to delayed presentation, difficulty in eliciting an accurate history, or trauma with unusual and highly contaminated objects. The possibility of initial misdiagnosis as panuveitis, metastatic endophthalmitis, and masquerade syndrome is also very high, which results not only in several unwarranted investigations being performed, but also a delay in the initiation of treatment. The standard treatment remains primary repair of the wound, intravitreal therapy with broad spectrum antibiotics, and parsplana vitrectomy. Despite appropriate intervention, visual outcome in children with posttraumatic endophthalmitis is dampened by additional factors like poor compliance with postoperative instructions and high risk of amblyopia. Hence, it is important to recognize that posttraumatic endophthalmitis in children differs from that in adults in several ways. We made a very tailored effort to review the published literature pertaining to posttraumatic endophthalmitis in children and herein present the results of our search.

Epidemiology, visual outcome, and hospitalization costs of open globe injury in northern Sardinia, Italy.

BACKGROUND: To investigate the epidemiology, visual outcome, and hospitalization costs of open globe injury in Northern Sardinia, Italy. METHODS: A population-based study involving all residents of Northern Sardinia. Hospital records were analyzed to obtain information on open globe injury. Age, gender, place of residence, occupation, cause of injury, circumstances, eye protection, visual outcome, and hospitalization costs were assessed. Statistical analysis was performed using an ordered probit estimate to calculate the predicted probability of visual outcome and a cross sectional linear regression model to evaluate some determinants of hospitalization costs. RESULTS: From 1993 to 2004, 176 residents (169 men, 7 women) were hospitalized for open globe injury. The overall annual incidence was 3.2 per 100,000. A bimodal age pattern was observed, with peaks at ages 20-24 and 50-59 years. The commonest occupation was "retired" (13.6%); 71% of injuries occurred during domestic or leisure activities. At the time of injury, 93.2% of patients were wearing no eye protection, 5.7% were wearing only ordinary spectacles, and 1.1% were wearing the correct protective equipment (safety goggles, shield). Final vision was < 3/60 in 27.3% of cases. Analyzing the predicted probability of blinding outcome, hospitalization costs were significantly influenced by greater age, retirement, residence in a rural area, and trauma occurrence during the weekend. CONCLUSIONS: Open globe injury in Northern Sardinia varied with age, gender, and residence, was associated with lack of eye protection, and often resulted in severe visual loss. People engaged in domestic or leisure activities, especially the retired, are at highest risk, suggesting the need for targeted messages. This could reduce the incidence of open globe injury and its associated costs on the community.

Open globe injuries: epidemiological study of two eye clinics in Germany, 1981-1999.

AIM: To analyze the epidemiology of open eye globe injuries and their treatment outcomes in patients treated at two university eye clinics in Germany in the past two decades. METHODS: Retrospective analysis was performed of medical records of 1,026 patients with open globe injuries primarily treated at the Universities of Freiburg and Wurzburg between January 1981 and December 1999. Final visual function was determined as a parameter of age, extent of injury, sex, cause of injury, and activity at the time of injury. Relative risk was calculated. RESULTS: After correction for the demographic distribution, the risk for open globe injury was 1.7 times the average for young adults and 0.6 for seniors. In the recent years, the risk for severe eye injury has been more equally distributed and is increasing for old people. The proportion of injuries at work decreased over the studied period from 42% to 32% for all open globe injuries, and the proportion of injuries in traffic accidents decreased from 30% to 4%. The number of eye injuries related to hobby activities increased. The proportion of enucleations and blindness decreased. Social life and income was moderately or severely impaired in 27% of patients after severe unilateral eye trauma. The median follow up of patients was 7 months. CONCLUSION: The prevalence and types of open globe injuries changed over the years, especially in relation to the law requiring seat belt use in traffic. The progress in surgical techniques led to a significant reduction in the number of blind eyes after injury. The proportion of enucleations and blindness decreased partly due to better surgical techniques, but mostly due to the decrease in injuries with usually poor outcome, such as gunshots, ruptures, and windscreen injuries.

Opportunities for maloccurrence in delivery of specialized care in the managed care environment.

Two patients lost eyes because of complications of retinal detachment in managed care situations. In both cases the eyes might have been saved had the patients been treated earlier by highly qualified subspecialists.

Ultrasound biomicroscopy in the assessment of penetrating or blunt anterior-chamber trauma.

Ultrasound biomicroscopy (UBM) was employed in the assessment of the anterior chamber in patients affected by penetrating and blunt traumas. UBM detected correctly the extent and the localization of penetrating injuries and the presence of foreign bodies, IOL dislocation, and angular structures or ciliary body damages.

Ocular injuries from violence treated at an inner-city hospital.

UNLABELLED: A computerized data base identified 277 patients with violence-related ocular injuries seen during 16 months in an inner-city hospital. They constituted 35% of all patients with ocular injuries during the study period. Their demographics and ocular findings were analyzed. One hundred sixty-seven patients (60%) were black males, 60 (22%) were white males, and 50 (18%) were females (mean age, 29 years). The orbit was injured in 125, the retina/choroid and vitreous in 79, and the optic nerve in ten. Seventeen had penetrating ocular injuries. Nineteen eyes (7%) lost light perception. One hundred forty-six (53%) patients had associated non-ocular injuries, mostly facial fractures. Bludgeons and guns were the weapons most commonly used; theft was the most common motive; drugs and alcohol were prominent in 35 cases. One hundred thirty-three (48%) patients were hospitalized for a mean of 5.5 days and an approximate cost of $975,089. CONCLUSION: the human suffering and economic impact of violence-related ocular injuries are significant.