Methotrexate reduces the complications of endophthalmitis resulting from intravitreal injection compared with dexamethasone in a rabbit model

Sophie X. Deng, Susan Penland, Sumit Gupta, Richard Fiscella, Deepak P. Edward, Howard H. Tessler, Debra A. Goldstein

Research output: Contribution to journalArticle

Abstract

PURPOSE. The incidence of infectious endophthalmitis associated with intravitreal injection (IVI) of steroid has been reported to be as high as 0.87%. This study was designed to investigate whether the antimicrobial activity of intravitreal methotrexate (MTX) alters the incidence or course of bacterial endophthalmitis associated with IVI in a rabbit model. METHODS. A rabbit model of endophthalmitis induced by Staphylococcus epidermidis (S) was established. Six groups of rabbits had IVI of sterile balanced salt solution (BSS), MTX (400 μg), dexamethasone (Dex, 200 μg), S, S and MTX (S-MTX), or S and dexamethasone (S-Dex). On days 0, 1, 3, 6, 10, and 14, total intraocular inflammation was measured in each animal. Vitritis was graded by the degree of vitreal haze. An intravitreal tap was performed on two animals from groups S, S-Dex, and S-MTX. A histopathologic study was performed on day 14. RESULTS. No endophthalmitis was observed in the control groups BSS, MTX, and Dex. Group S-Dex had the highest and group S-MTX had the least total ocular inflammation and vitritis scores from days 3 to 14. The difference in total inflammation and vitritis among groups S, S-Dex, and S-MTX is significant (P = 0.046 and P = 0.001, respectively). Live bacteria were isolated only from groups S and S-Dex. Pathology revealed severe ocular destruction in groups S and S-Dex and intact structures in group S-MTX. CONCLUSIONS. MTX appears to reduce the risk of development of bacterial endophthalmitis and ocular destruction associated with IVI compared with Dex. IVI of MTX may be a safer alternative than steroid injection in treating noninfectious uveitis.

Original languageEnglish (US)
Pages (from-to)1516-1521
Number of pages6
JournalInvestigative Ophthalmology and Visual Science
Volume47
Issue number4
DOIs
StatePublished - Apr 2006
Externally publishedYes

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Intravitreal Injections
Endophthalmitis
Methotrexate
Dexamethasone
Rabbits
Inflammation
Salts
Steroids
Staphylococcus epidermidis
Incidence
Uveitis
Pathology
Bacteria
Control Groups
Injections

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Methotrexate reduces the complications of endophthalmitis resulting from intravitreal injection compared with dexamethasone in a rabbit model. / Deng, Sophie X.; Penland, Susan; Gupta, Sumit; Fiscella, Richard; Edward, Deepak P.; Tessler, Howard H.; Goldstein, Debra A.

In: Investigative Ophthalmology and Visual Science, Vol. 47, No. 4, 04.2006, p. 1516-1521.

Research output: Contribution to journalArticle

Deng, Sophie X. ; Penland, Susan ; Gupta, Sumit ; Fiscella, Richard ; Edward, Deepak P. ; Tessler, Howard H. ; Goldstein, Debra A. / Methotrexate reduces the complications of endophthalmitis resulting from intravitreal injection compared with dexamethasone in a rabbit model. In: Investigative Ophthalmology and Visual Science. 2006 ; Vol. 47, No. 4. pp. 1516-1521.
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abstract = "PURPOSE. The incidence of infectious endophthalmitis associated with intravitreal injection (IVI) of steroid has been reported to be as high as 0.87{\%}. This study was designed to investigate whether the antimicrobial activity of intravitreal methotrexate (MTX) alters the incidence or course of bacterial endophthalmitis associated with IVI in a rabbit model. METHODS. A rabbit model of endophthalmitis induced by Staphylococcus epidermidis (S) was established. Six groups of rabbits had IVI of sterile balanced salt solution (BSS), MTX (400 μg), dexamethasone (Dex, 200 μg), S, S and MTX (S-MTX), or S and dexamethasone (S-Dex). On days 0, 1, 3, 6, 10, and 14, total intraocular inflammation was measured in each animal. Vitritis was graded by the degree of vitreal haze. An intravitreal tap was performed on two animals from groups S, S-Dex, and S-MTX. A histopathologic study was performed on day 14. RESULTS. No endophthalmitis was observed in the control groups BSS, MTX, and Dex. Group S-Dex had the highest and group S-MTX had the least total ocular inflammation and vitritis scores from days 3 to 14. The difference in total inflammation and vitritis among groups S, S-Dex, and S-MTX is significant (P = 0.046 and P = 0.001, respectively). Live bacteria were isolated only from groups S and S-Dex. Pathology revealed severe ocular destruction in groups S and S-Dex and intact structures in group S-MTX. CONCLUSIONS. MTX appears to reduce the risk of development of bacterial endophthalmitis and ocular destruction associated with IVI compared with Dex. IVI of MTX may be a safer alternative than steroid injection in treating noninfectious uveitis.",
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T1 - Methotrexate reduces the complications of endophthalmitis resulting from intravitreal injection compared with dexamethasone in a rabbit model

AU - Deng, Sophie X.

AU - Penland, Susan

AU - Gupta, Sumit

AU - Fiscella, Richard

AU - Edward, Deepak P.

AU - Tessler, Howard H.

AU - Goldstein, Debra A.

PY - 2006/4

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N2 - PURPOSE. The incidence of infectious endophthalmitis associated with intravitreal injection (IVI) of steroid has been reported to be as high as 0.87%. This study was designed to investigate whether the antimicrobial activity of intravitreal methotrexate (MTX) alters the incidence or course of bacterial endophthalmitis associated with IVI in a rabbit model. METHODS. A rabbit model of endophthalmitis induced by Staphylococcus epidermidis (S) was established. Six groups of rabbits had IVI of sterile balanced salt solution (BSS), MTX (400 μg), dexamethasone (Dex, 200 μg), S, S and MTX (S-MTX), or S and dexamethasone (S-Dex). On days 0, 1, 3, 6, 10, and 14, total intraocular inflammation was measured in each animal. Vitritis was graded by the degree of vitreal haze. An intravitreal tap was performed on two animals from groups S, S-Dex, and S-MTX. A histopathologic study was performed on day 14. RESULTS. No endophthalmitis was observed in the control groups BSS, MTX, and Dex. Group S-Dex had the highest and group S-MTX had the least total ocular inflammation and vitritis scores from days 3 to 14. The difference in total inflammation and vitritis among groups S, S-Dex, and S-MTX is significant (P = 0.046 and P = 0.001, respectively). Live bacteria were isolated only from groups S and S-Dex. Pathology revealed severe ocular destruction in groups S and S-Dex and intact structures in group S-MTX. CONCLUSIONS. MTX appears to reduce the risk of development of bacterial endophthalmitis and ocular destruction associated with IVI compared with Dex. IVI of MTX may be a safer alternative than steroid injection in treating noninfectious uveitis.

AB - PURPOSE. The incidence of infectious endophthalmitis associated with intravitreal injection (IVI) of steroid has been reported to be as high as 0.87%. This study was designed to investigate whether the antimicrobial activity of intravitreal methotrexate (MTX) alters the incidence or course of bacterial endophthalmitis associated with IVI in a rabbit model. METHODS. A rabbit model of endophthalmitis induced by Staphylococcus epidermidis (S) was established. Six groups of rabbits had IVI of sterile balanced salt solution (BSS), MTX (400 μg), dexamethasone (Dex, 200 μg), S, S and MTX (S-MTX), or S and dexamethasone (S-Dex). On days 0, 1, 3, 6, 10, and 14, total intraocular inflammation was measured in each animal. Vitritis was graded by the degree of vitreal haze. An intravitreal tap was performed on two animals from groups S, S-Dex, and S-MTX. A histopathologic study was performed on day 14. RESULTS. No endophthalmitis was observed in the control groups BSS, MTX, and Dex. Group S-Dex had the highest and group S-MTX had the least total ocular inflammation and vitritis scores from days 3 to 14. The difference in total inflammation and vitritis among groups S, S-Dex, and S-MTX is significant (P = 0.046 and P = 0.001, respectively). Live bacteria were isolated only from groups S and S-Dex. Pathology revealed severe ocular destruction in groups S and S-Dex and intact structures in group S-MTX. CONCLUSIONS. MTX appears to reduce the risk of development of bacterial endophthalmitis and ocular destruction associated with IVI compared with Dex. IVI of MTX may be a safer alternative than steroid injection in treating noninfectious uveitis.

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