Effects of inflammation and surgery on amikacin levels in the vitreous cavity

Abstract

Intraocular injection of amikacin is increasingly used in the treatment of endophthalmitis. We injected 400 micrograms of amikacin into the vitreous cavity of rabbit eyes to study its pharmacokinetics. Phakic, aphakic, and aphakic vitrectomized eyes were injected, and inflamed eyes were compared to control eyes. Vitreous concentrations were determined at two, eight, 24, and 48 hours, and clearance rates were calculated. Amikacin is cleared considerably more quickly from aphakic (half-life, 14.3 hours) than phakic control eyes (half-life, 25.5 hours) and even more quickly from aphakic vitrectomized eyes (half-life, 7.0 hours). Inflammation substantially increased the rate of clearance in aphakic eyes. In inflamed aphakic and aphakic vitrectomized eyes, vitreous drug levels were equal to or below the minimal inhibitory concentration for most organisms considered sensitive to amikacin at 24 hours. Supplementation of intraocular antibiotics may therefore be required in clinical settings.