Daptomycin versus Vancomycin in an Enterococcus faecalis Endophthalmitis Rabbit Model.

PURPOSE: To compare bactericidal activities of daptomycin (DAP) and vancomycin (VAN) in an experimental rabbit model of Enterococcus faecalis endophthalmitis. MATERIALS AND METHODS: The right vitreous cavities of 24 New Zealand rabbits were inoculated with 100 colony-forming units of E. faecalis; and after 24 h, rabbits were randomly divided into three groups. DAP group (n = 8, 0.2 mg/0.05 ml intravitreally), VAN group (n = 8, 1 mg/0.05 ml intravitreally) and balanced salt solution group (BSS, n = 8, 0.05 ml intravitreally). Clinical examination scores were recorded, and vitreous aspirates were obtained for microbiological analysis on days 0, 1, 2, 3 and 4. Rabbits were sacrificed, and the eyes were enucleated for histopathological assessment. RESULTS: There was no difference between the DAP, VAN and BSS groups in terms of the clinical grading of endophthalmitis 24 h after the inoculation. The bacterial counts were similar between the VAN and DAP groups except on day 1, where it was significantly lower than those in the VAN group (p = 0.003). On day 4, 62% of the eyes treated with DAP, and 50% of the eyes treated with VAN were sterilized. All of the eyes from the BSS group showed increasing bacterial growth from day 0 to day 4. There was no difference between the DAP and VAN groups in terms of the histopathological and clinical examination scores, while they were significantly lower than those in the BSS group. CONCLUSIONS: This study demonstrates evidence of the effectiveness of DAP for the treatment of experimental E. faecalis endophthalmitis.

Effect of mitomycin C on revision endoscopic dacryocystorhinostomy.

OBJECTIVE: The objectives of the study were to compare the outcome and success rate of revision endoscopic dacryocystorhinostomy (EN-DCR) with or without use of adjunctive mitomycin C (MMC) in cases with dacryocystorhinostomy (DCR) failure. METHODS: Thirty-six consecutive adult patients underwent revision EN-DCR. The patients were divided into 2 groups. In group 1 (18 patients), a neurosurgical cottonoid soaked in MMC at 0.5 mg/mL was placed at the osteotomy site for 5 minutes (using canalicular silicone intubation tube). In the other group (18 patients), standard endoscopic dacryocystorhinostomy technique was used without MMC (using canalicular silicone intubation tube). Successful DCR was defined as relief of symptoms (resolution of epiphora and absence of discharge) as demonstrated by saline irrigation at the last postoperative visit. RESULTS: The EN-DCR procedure with adjunctive MMC was successful in 16 (88.88%) cases. The mean follow-up was 11.5 months (7-19 months). No significant complications were encountered. In the control group, the EN-DCR was successful in 10 patients (55.55%). The mean follow-up was 12.7 months (6-22 months). The difference between the 2 groups was statistically significant (P < 0.05). CONCLUSIONS: Recurrent nasolacrimal duct obstruction after primary DCR is mainly due to reclosure of the nasolacrimal stoma and osteotomy site with granulation tissue. Adjunctive use of intraoperative MMC seems to be a safe adjuvant that could help in increasing the success rates of revision EN-DCR surgery.