Human vitreous levels of selected antistaphylococcal antibiotics.

Staphylococcus epidermidis and S. aureus are the most common causes of bacterial endophthalmitis. A study of the penetration of selected antistaphylococcal antibiotics into human vitreous was undertaken in 58 patients. After 2-g intravenous doses of cephalothin, cefazolin, methicillin, oxacillin, or nafcillin were given to patients about to undergo vitreous surgery, mean vitreous levels for each antibiotic were as follows: cephalothin, 0.97 microgram/ml in diabetics and 0.69 microgram/ml in nondiabetics; cefazolin, 0.84 microgram/ml in diabetics and 1.6 microgram/ml in nondiabetics; methicillin, 2.56 micrograms/ml in diabetics and 2.64 micrograms/ml in nondiabetics; oxacillin, 0.62 microgram/ml in diabetics and 0.34 microgram/ml in nondiabetics; and nafcillin, 0.73 microgram/ml in diabetics and 0.75 microgram/ml in nondiabetics. Only cefazolin produced vitreous concentrations consistently above its minimum inhibitory concentration for 90% of S. epidermidis isolates. Staphylococcus aureus isolates were not similarly covered. There was a trend toward higher vitreous antibiotic concentrations in patients with proliferative vitreoretinopathy and rubeosis.

Penetration of imipenem into human aqueous and vitreous humor.

Twenty-five patients about to undergo cataract surgery and ten patients about to undergo vitrectomy received a 1-g intravenous dose of imipenem before surgery. Specimens of aqueous or vitreous humor were then obtained and assayed for antibiotic content with a microbiologic disk agar technique. A mean peak aqueous humor level of 2.99 micrograms/ml was found at approximately two hours after administration, and a mean vitreous level of 2.53 micrograms/ml was found from two hours to three hours 15 minutes after administration. These concentrations were well above the minimum inhibitory concentration of imipenem for 90% (MIC90) of Staphylococcus epidermidis, S. aureus, and the Enterobacteriaceae commonly involved in bacterial endophthalmitis.

Human vitreous levels of cefamandole and moxalactam.

We gave 2-g intravenous doses of either cefamandole or moxalactam to 22 patients before vitrectomy. At 1 1/2 to 2 1/2 hours after administration, cefamandole vitreous concentrations varied from 0.36 to 2.05 micrograms/ml (mean, 0.94 micrograms/ml). Individual levels above the minimum inhibitory concentration of cefamandole for 90% (MIC90) of Staphylococcus aureus were found in five of 11 patients. Levels above the MIC90 for S. epidermidis were found in only two of 11 samples. Vitreous concentrations above the MIC90 of cefamandole for common gram-negative pathogens were found in only two patients. Moxalactam concentrations in the vitreous varied from 1.1 to 4 micrograms/ml 30 minutes to six hours after administration. These levels were not above moxalactam's MIC90 for S. aureus or S. epidermidis but were many times higher than the MIC90 of moxalactam for Enterobacteriaceae excluding Pseudomonas.

An apparent small cluster of choroidal melanoma cases.

Three choroidal melanomas were detected in a 2.5-year period in a small community of 3,592 persons. This small cluster represented an incidence about 20 times that expected (P = .0006). The community has an isolated water supply and very little industry. We determined the incidence of cancer in this and two adjacent communities and found no other unexpectedly high incidence. The three patients had no common exposures. Analyses of air and water from the involved community by mass spectroscopy, chromatography, and Ames (mutagenicity) tests were noncontributory. Nine of 60 mice given community water after weaning developed lens opacities eight to 16 months later; electron microscopy showed an abnormal monolayer of cells on the outer surface of the anterior lens capsule. The genesis of this monolayer was not clear. None of the 30 controls showed such lesions.

Familial exudative vitreoretinopathy.

Two sisters and a brother with the syndrome of familial exudative vitreoretinopathy are described (FEV). Findings associated with this condition include temporal neovascularization, vitreous hemorrhage, and retinal detachment. Familial exudative vitreoretinopathy is a genetic syndrome with nearly complete penetrance but widely variable expressivity. The differential diagnosis is fairly extensive. This condition is sometimes confused with retrolental fibroplasia, and FEV is probably a more frequently occurring disease than previously thought, because of confusion with RLF. The pathophysiologic mechanism, natural history, and optimal treatment of this disease are matters of debate. With active surgical management, three of the four eyes which presented to us for treatment have visual acuity of 20/30 or better.

Wagner's vitreoretinal degeneration.

Four members of a black family with findings of Wagner's vitreoretinal degeneration are described in this paper. All present with the classical findings of an optically clear vitreous and pigment abnormalities of the fundus varying from fine perivascular to dense peripheral pigment clumping. In addition, the characteristic associated findings of high myopia, gluccoma, presenile cataract formation, choroidal atrophy, and retinal detachment are documented. To our knowledge, we believe these to be the first cases of Wagner's disease to be presented in a nonwhite pedigree.

Delayed onset chloroquine retinopathy: case report.

A patient presented with decreased visual acuity and retinal findings compatible with chloroquine retinopathy 5 years after discontinuing regular usage of chloroquine for rheumatoid arthritis. A review of the literature on chloroquine retinopathy is outlined. In addition, the characteristic findings including fluorescein angiography, retinal physiologic studies, and symptoms are reviewed. Chloroquine retinopathy is dose related and essentially irreversible and often progressive once typical findings are noted. To our knowledge very delayed onset of chloroquine retinopathy is a relatively rare phenomenon but the medical and ophthalmic communities must be alerted to the possibly severe complications of this iatrogenic disease entity.