Pediatric Traumatic Retinal Detachments: Clinical Characteristics and Outcomes.

BACKGROUND AND OBJECTIVE: To compare clinical characteristics and surgical outcomes of retinal detachment (RD) after open globe injuries (OGIs) and closed globe injuries (CGIs). PATIENTS AND METHODS: One hundred ten eyes of 110 patients aged 17 years or younger who underwent primary RD repair after OGI and CGI between 2010 and 2013 were reviewed retrospectively. RESULTS: Cataract (59.8% vs. 21.7%; P = .002) and vitreous hemorrhage (54% vs. 13%; P < .001) were significantly higher in OGIs than CGIs. Anatomical success rates were 75.9% in OGI and 82.6% in CGI (P = .586). Final visual acuity of 20/200 or greater was obtained in 23% of OGIs and 47.8% of CGIs (P = .035). Advanced proliferative vitreoretinopathy was associated with poor anatomical and visual outcome in both OGIs and CGIs. In OGIs, macular detachment was associated with poor visual outcome, and in CGIs, vitrectomy and macular detachment were associated with poor visual outcome. CONCLUSION: Visual outcomes were not compatible with anatomical success in both groups. Advanced PVR seems to be the most prominent factor that influences the anatomical and functional success rates in both OGI and CGI. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:143-150.].

Interferon Alpha-2a Therapy in Patients with Refractory Behçet Uveitis.

PURPOSE: To report the results of IFNα2a therapy in patients with Behçet uveitis refractory to azathioprine-cyclosporine combination treatment. METHODS: In a retrospective study, 39 patients treated with either azathioprine-cyclosporine combination treatment (group 1, n = 23) or IFNα2a (group 2, n = 16) with a diagnosis of ocular Behçet disease (BD), were included in the study. Group 2 consisted of patients who did not respond to conventional combination therapy, and were therefore treated with IFNα2a. Clinical response and relapse rates were recorded for each group. RESULTS: The mean number of uveitis attacks/year per patient was 0.8 ± 1.6 in Group 1. In Group 2, a significant decrease in the mean number of uveitis attacks/year per patient was observed after initiation of IFNα2a (2.4 ± 1.8 vs 1.3 ± 2.0) (p<0.05). When the two groups were compared after administration of IFNα2a therapy, no statistical difference was found in terms of uveitis attack/year and attack-free intervals, with a partial response to both treatments. CONCLUSIONS: IFNα2a therapy is an effective alternative for Behçet uveitis patients where conventional combination therapy fails.

Neuroprotective effect of systemic and/or intravitreal rosuvastatin administration in rat glaucoma model.

AIM: To evaluate the neuroprotective effect of rosuvastatin, in a rat experimental glaucoma model. METHODS: Ocular hypertension was induced in right eyes of Long-Evans rats (n=30) by cauterization of three episcleral veins. Left eyes were defined as controls. Rats were divided into five groups: oral rosuvastatin, intravitreal rosuvastatin, oral+intravitreal rosuvastatin, intravitreal sham and glaucoma without intervention. Rats were sacrificed at day 14. Retinal ganglion cell (RGC) number was assessed by histopathological analysis. Terminal deoxynucleotidyl transferase-mediated dUTP-nick end-labeling (TUNEL) staining and the expression of glial fibrillary acidic protein (GFAP) in RGC layer was also examined. RESULTS: A significant intraocular pressure (IOP) elevation was seen (P=0.002). Elevated IOP resulted in a significant decrease in number of RGCs in group 5 (70.33±8.2 cells/mm(2)) when compared with controls (92.50±13.72 cells/mm(2); P=0.03). The RGC number in group 1 (92.4±7.3 cells/mm(2)) was significantly higher than group 5 (P=0.03). The numbers of RGC in groups 2, 3 (57.3±8.2 cells/mm(2), 60.5±12.9 cells/mm(2)) were comparable with that of group 5 (P=0.18 and P=0.31). The apoptosis rates with TUNEL staining were also parallel to RGC number. Animals with experimentally induced glaucoma showed an increase in retinal GFAP immunoreactivity. CONCLUSION: Decrease in RGC loss and apoptosis suggest the neuroprotective potential of oral rosuvastatin treatment in a rat model of ocular hypertension. However intravitreal rosuvastatin showed a contrary effect and further studies are required.

Pediatric open-globe injuries: clinical characteristics and factors associated with poor visual and anatomical success.

PURPOSE: We determine the clinical characteristics, visual and anatomical outcomes, and factors associated with poor visual outcome and anatomical success in pediatric open-globe injuries (OGI). METHODS: The records of patients aged 17 years and younger who had undergone surgical intervention after OGI between January 2000 and June 2010 were reviewed retrospectively. RESULTS: In total, 182 patients were enrolled in the study (70.9 % males, 29.1 % females; mean age: 8.6 ± 4.5 years [range 1-17 years]). Injuries occurred mostly at home (45.1 %). Objects most often causing the ocular trauma were sharp objects (74.1 %). Over one-third of the eyes (39.7 %) had final visual acuities of 20/200 or better. Anatomical success was achieved in 76.9 % of eyes. Time between primary globe repair and secondary surgical intervention was 61.4 ± 144 days. Visual outcomes were poor in eyes with initial visual acuity less than for counting fingers, retinal detachment, proliferative vitreoretinopathy, and endophthalmitis. Anatomical success rates were low with retinal detachment. CONCLUSION: Visual outcomes seem to be poor in more than half of the patients despite advanced microsurgical techniques.

Retinal vessel diameters and their correlation with retinal nerve fiber layer thickness in patients with pseudoexfoliation syndrome.

AIM: To compare retinal artery-vein diameters (RAVDs) of patients with pseudoexfoliation (PSX) syndrome with healthy controls and investigate the correlations between retinal nerve fiber layer (RNFL) thickness parameters and RAVDs. METHODS: Seventeen eyes with PSX and 17 eyes of age-matched controls were included in the study. All participants underwent routine ophthalmological examination, Humphrey visual field and RNFL examination by using Stratus OCT. Retinal images were obtained by using a retinal camera (Topcon 501X). RAVDs were measured from inferior nasal, inferior temporal, superior nasal and superior temporal arcuates by using IMAGEnet software. Superior, inferior, nasal, temporal and average RNFL thicknesses were recorded. RAVDs and RNFL parameters in groups and correlations were analyzed by Mann-Whitney U and Spearmann correlation tests. RESULTS: Only inferior quadrant and average RNFL thickness were detected thinner in the PSX group compared with control group (P=0.009, P=0.038, respectively). No statistically significant difference regarding RAVDs was found between two groups. CONCLUSION: RAVDs seems to be comparable in the PSX and control group. RNFL is thinner in the inferior quadrant in the PSX group. RNFL thickness and RAVDs show significant correlations in both groups. This correlation doesn't seem to be specific to PSX.

Unilateral sequential papillophlebitis and central retinal artery occlusion in a young healthy patient.

A 23-year-old girl presented to the clinic with metamorphopsia and photopsia in her left eye. After detailed ophthalmic examination, central retinal vein occlusion with optic disc edema was detected in that eye. Three days after diagnosis, the patient returned to our clinic with visual acuity decrease. Central retinal artery occlusion sparing cilioretinal artery was detected. All the laboratory tests were normal except for heterozygous methylenetetrahydrofolate reductase mutation (A1298C genotypes) and an indefinite Lyme disease seropositivity. Symptoms and visual disturbance recovered without any further treatment other than acetylsalicylic acid for prophylaxis.

The effect of systemic erythropoietin treatment on retinal nerve fiber layer parameters in patients with chronic renal failure undergoing peritoneal dialysis.

PURPOSE: To evaluate the effect of erythropoietin (EPO) treatment on retinal nerve fiber layer (RNFL) parameters in patients with chronic renal failure (CRF) undergoing peritoneal dialysis (PD). METHODS: Fifty-eight eyes of 29 patients with CRF undergoing PD were evaluated. Fifteen patients have been treated with EPO (group 1), 14 patients without EPO treatment (group 2), and 30 eyes of 15 age-matched normal control subjects were assessed in group 3. A complete ophthalmologic examination and RNFL measurements were performed for each patient after PD. Anemia parameters were also measured. RNFL thickness protocol was used to acquire circular scans of 3.4 mm in diameter around optic nerve. RNFL thicknesses were evaluated in 4 quadrants. Only the left eyes were recruited for statistical analysis. The mean and quadrantal RNFL thickness values in group 1 were compared with those of groups 2 and 3. RESULTS: The mean RNFL thickness values in patients undergoing PD were statistically lower than the control group at superior, inferior, nasal, and temporal quadrant, respectively (P=0.03, 0.04, 0.04, and 0.03). Differences between the RNFL thickness values in group 1 and group 2 were statistically significant only in the temporal quadrant (P=0.02). CONCLUSIONS: In patients with CRF undergoing PD, RNFL thickness parameters were found to be significantly reduced. The effect of EPO on RNFL parameters was statistically significant only in the temporal quadrant.

The effects of tamsulosin and alfuzosin on iris morphology: an ultrasound biomicroscopic comparison.

CONTEXT: It is well known that Alpha-1 adrenergic receptor antagonists affect the receptors in the prostate and also iris dilator muscle, leading to loss of iris muscle tone. OBJECTIVE: To compare morphological alterations of iris secondary to tamsulosin and alfuzosin use. PARTICIPANTS: Patients included in the study were grouped as follows: 16 patients treated with tamsulosin (Group 1), 14 patients treated with alfuzosin (Group 2) and 18 untreated controls (Group 3). MATERIALS AND METHODS: All patients underwent ultrasound biomicroscopic and pupillometric examination. Iris thickness was measured at the dilator muscle region (DMR; measured at half of the distance between the scleral spur and the pupillary margin) and sphincter muscle region (SMR; Standardized at 0.75 mm from the pupillary margin). DMR/SMR was also calculated for each patient. Differences among groups were analysed. Main outcome measures were DMR, SMR, DMR/SMR and pupillary diameter. RESULTS: Mean duration of treatments were 2.4 ± 0.96 years (1-4) and 2.3 ± 1.01 years (1-4) in Groups 1 and 2. Pupillary diameters were reduced in Groups 1-2 compared to Group 3 (p < 0.001, p < 0.001). The SMR was similar in Groups 1 and 2 (p: 0.114). These values were not significantly different from that of Group 3 (p: 0.196, p: 0.209). However, thickness in the DMR in Groups 1-2 were significantly lower than that of controls (Group 3) whereas there was no significant difference between Groups 1 and 2 (p: 0.041, p: 0.039 and 0.986, respectively). Mean DMR/SMR ratios were significantly lower in Groups 1-2 than that of Group 3 (p: 0.040 and p: 0.040, respectively). CONCLUSIONS: In patients using these medications, the iris seems to be thinner at the dilator muscle region, but preserving the sphincter muscle region.

A histological study of rabbit corneas after transepithelial corneal crosslinking using partial epithelial photoablation or ethanol treatment.

AIM: To evaluate the histological changes after transepithelial corneal crosslinking (CXL) using partial thickness excimer laser ablation or epithelial ethanol application in an experimental rabbit study. METHODS: Right eyes of twenty-four rabbits were studied. Four eyes received total epithelial debridement (group I). Four eyes received partial thickness epithelial ablation with excimer laser (group II). Twelve eyes were treated with different durations (30s and 60s) and concentrations (18% to 48%) of ethanol (group III). Riboflavin was applied for 30min intervals along with topical proparacaine drops with benzalkonium chloride, and 370 nm irradiation was performed for 30min, while riboflavin was instilled every 3min. Four eyes (group IV) received 48% ethanol for 30s without riboflavin and irradiation. Eyes were collected after 24h and examined histologically. RESULTS: All eyes in group I showed keratocyte loss in the superficial 300 µ of corneal storma. In group II, 1-4 layers of epithelium were preserved and no keratocyte loss occurred. In group III, CXL after treatment with ethanol up to 24% concentration and up to 60s revealed no keratocyte loss. CXL after treatment with 48% and higher ethanol concentrations yielded keratocyte loss in the superficial 200 µ to 300 µ of cornea. CONCLUSION: Incomplete excimer laser ablation of the epithelium or treatment with ethanol up to 24% concentration and up to 60s duration yielded no stromal keratocyte loss. To get the same histological appearance seen in epithelial debridement group, partial thickness excimer laser epithelial ablation or ethanol application is not adequate for transepithelial CXL.

Trabeculectomy with large area mitomycin-C application as a first-line treatment in advanced glaucoma: retrospective review.

AIM: To evaluate the outcomes of trabeculectomy with large area mitomycin-C (MMC) application as a first line treatment in advanced glaucoma. METHODS: The records of 55 patients with severe visual field defects undergoing trabeculectomy were retrospectively reviewed. The patients were classified as first-line therapy to either early trabeculectomy (initial trabeculectomy-Group 1) or long term medical therapy followed by trabeculectomy (primary trabeculectomy-Group 2). Trabeculectomy was performed with large-area MMC application. Intraocular pressure (IOP) values, visual acuities, mean deviations, morphology and function of the blebs, necessity for anti-glaucomatous medications and surgical complications were reported. RESULTS: There were 20 eyes of 18 patients in Group 1 and 37 eyes of 37 patients in Group 2. The mean preoperative IOPs in Groups 1 and 2 were 40.2±10.0mmHg (27-68mmHg) and 29.0±4.4mmHg (21-41mmHg), respectively (P=0.001). Average preoperative mean deviations (MD) in Groups 1 and 2 were 17.4±2.8dB (13.3-23dB) and 17.9±2.4 dB (13.7-23.2dB), respectively (P=0.441). Postoperative IOPs significantly decreased and were comparable in both Groups. The mean number of medications was significantly higher in Group 2 (P=0.005). No cystic bleb formation was observed in Group 1, whereas 4 patients from Group 2 (10.8 %) developed cystic bleb (P=0.040). No visually devastating complication has occurred in both Groups. CONCLUSION: Initial trabeculectomy with large area MMC application might be applied in patients with advanced glaucoma with low complication rates. Long-term topically applied anti-glaucomatous medications seem to increase the risk of cystic bleb formation.

Comparison of acute effect of systemic versus intravitreal infliximab treatment in an experimental model of endotoxin-induced uveitis.

PURPOSE: In this study, we investigated the efficacy of systemic and intravitreal (IV) infliximab treatments and compared these 2 different treatment modalities in an experimental model of endotoxin-induced uveitis (EIU). METHODS: Twenty-four white New Zealand rabbits were equally divided into 4 groups. Group 1 received IV injection of lipopolysaccharide (LPS), group 2 received IV injections of LPS and saline, group 3 received IV LPS and IV 2 mg/0.1 cc infliximab, and group 4 received IV LPS and 5 mg/kg intravenous infliximab. Inflammation was determined with objective and subjective tests. The subjective test was clinical determination of uveitis, the objective tests were determination of protein concentrations and tumor necrosis factor alpha (TNF-α) levels and histopathology. RESULTS: Clinical examination score was lower in group 3 and group 4 (4±0.6 and 3.5±1.6, respectively) when compared with group 1 (P=0.02; P=0.04, respectively) and group 2. In group 3 and 4, the aqueous and vitreous protein and TNF-α concentration measured significantly lower than group 1 and 2. In histopathologic examination, there was no statistically significant difference between group 1, 2, and 3 (3.5±0.5, 3.6±0.5, 3.6±0.5, respectively). However, the lowest histopathologic inflammation was determined in group 4 (2.5±0.5) (compared with group 1 and group 3, respectively; P=0.03; P=0.014). CONCLUSION: In a rabbit model of experimental EIU, intravenous administration of infliximab was more effective than IV route in an acute period.

Vitreous and aqueous penetration of intravitreally and orally administered moxifloxacin in an experimental rabbit model of fungal endophthalmitis.

OBJECTIVES: Moxifloxacin (MXF), is a fluoroquinolone drug thought to have some antifungal activity against Candida albicans. The aim of our study was to investigate whether intravitreally and orally administered MXF has an effective penetration into the aqueous and vitreous in an experimental model of C. albicans endophthalmitis. METHODS: Thirty-two New Zealand rabbits were included. Endophthalmitis was induced in the right eyes of the rabbits. Left eyes were used as sham controls. Group 1 received a single dose of 160 µg MXF/0.1 ml intravitreally. Group 2 received a single intravitreal dose of 160 µg MXF/0.1 ml and an oral dose of 7 mg/kg/day for 4 days. Group 3 received only an oral dose of MXF 7 mg/kg/day for 4 days. Group 4 comprised of healthy controls. On the first and fourth day of treatment aqueous and vitreous samples were aspirated to compare the penetration of MXF. KEY FINDINGS: Between the first and fourth days, in group 1, mean MXF levels in the aqueous and vitreous tended to decrease; however, in group 3, these drug levels were tended to increase. There was also a decline in the drug levels in the aqueous and vitreous of group 2. CONCLUSIONS: MXF cannot achieve sufficient penetration into the aqueous and vitreous of eyes infected with C. albicans.

Intravitreal bevacizumab treatment for refractory diabetic macular edema.

To evaluate the effect of intravitreal bevacizumab (IVB) on visual function and retinal thickness in patients with refractory diabetic macular edema (DME). Eyes with DME treated with IVB which were resistant to different previous treatments were enrolled in this retrospective, non-randomized series study. Each patient underwent a complete ophthalmic examination including best-corrected visual acuity (BCVA), slit-lamp examination, intraocular pressure measurement, fundus examination, retinal thickness measurement with optic coherence tomography at baseline and at each visit. Digital fundus fluorescein angiography was performed at baseline for each patient. A total of 71 eyes of 59 patients (36 male and 23 female) were included in the study. All eyes had focal laser photocoagulation (71 eyes, 100 %) and had one other additional treatment including an intravitreal (23 eyes, 32 %) or subtenon (18 eyes, 25 %) injection of triamcinolone acetonide. The mean follow-up period was 9.79 ± 8.6 months and the mean number of IVB treatments was 2.01 ± 1.06 (min-max, 1-4). Mean logMAR BCVA was 0.88 ± 0.4 at baseline, 0.78 ± 0.4 at 4 weeks and 0.79 ± 0.4 at the last visit (p = 0.036). The mean central foveal thickness was 515.4 ± 150.3 µm at baseline which significantly decreased to 367.01 ± 166.6 µm at 4 weeks (p = 0.0001) and 338.1 ± 159.7 µm at the last visit (p = 0.0001). Sixteen percent of the eyes did not respond to IVB treatment. IVB treatment for refractory DME seems to be effective and safe and repeated treatments are necessary for a significant portion of the cases.

Childhood glaucoma as an ophthalmic manifestation of Seckel syndrome.

PURPOSE: The purpose of the study was to report a patient with Seckel syndrome associated with high intraocular pressures despite intensive antiglaucoma treatment. METHODS: Case report. RESULTS: High intraocular pressure readings in both eyes measured with the Goldman applanation tonometer, bilateral pigmentary retinopathy and total cupping of optic discs were found. The patient underwent bilateral trabeculectomy surgery as he had medically uncontrolled glaucoma. CONCLUSIONS: Childhood glaucoma may be associated with Seckel syndrome.

Comparison of efficacy and safety between transconjunctival 23-gauge and conventional 20-gauge vitrectomy systems in macular surgery.

PURPOSE: To compare the efficacy and safety of 23-gauge transconjunctival vitrectomy with the conventional 20-gauge method in idiopathic epiretinal membrane and macular hole surgery. METHODS: Sixty-one consecutive patients undergoing vitrectomy for idiopathic epiretinal membrane and macular hole were recruited to either 20- or 23-gauge vitrectomy groups and prospectively evaluated. Surgical success rates, operating time, surgery-related complications, long-term visual outcomes, and postoperative ocular surface problems are compared in the two groups. RESULTS: There were 31 eyes in the 20-gauge group and 33 eyes in the 23-gauge group. The macular hole closure rate after the first surgery was 83% and 90.9% in the 20-gauge and 23-gauge groups, respectively, with no significant difference between groups (p = 0.59). The success rate for idiopathic epiretinal membranes cases was 100% in both groups. There was no statistically significant difference between overall surgical times (p = 0.90). None of the patients in either group experienced postoperative complications of severe postoperative hypotony, vitreous hemorrhage or endophthalmitis, except one eye in the 20-gauge group, which was found to have retinal detachment. In both groups, statistically significant improvement in visual acuity was achieved 1-month postoperatively (p = 0.002) and thereafter at all postoperative visits (p < 0.05). The mean ocular surface scores were significantly lower in the 23-gauge group at all postoperative visits compared with the 20-gauge group scores (p = 0.001). CONCLUSIONS: Transconjunctival 23-gauge vitrectomy appears to be as effective and safe as conventional 20-gauge vitrectomy in idiopathic epiretinal membrane and macular hole surgeries.

Photodynamic therapy for best disease complicated by choroidal neovascularization in children.

PURPOSE: To describe the results of photodynamic therapy (PDT) with verteporfin for the treatment of choroidal neovascularization (CNV) associated with Best vitelliform macular dystrophy (BVMD) in children. METHODS: Five eyes of four children diagnosed as having BVMD complicated by CNV received a single session of PDT. Response to treatment was monitored with fluorescein angiography and optical coherence tomography. RESULTS: All eyes responded well to one session of PDT with significant increases in visual acuity in four of the five eyes. Increase or stabilization of visual acuity was preserved during a mean follow-up period of 25 months. CONCLUSION: PDT may be an effective treatment for CNV associated with BVMD in children.

Comparison of intravitreal triamcinolone treatment and intravitreal triamcinolone with grid laser treatment in patients with diffuse diabetic macular edema.

OBJECTIVE: To compare the efficacy of intravitreal triamcinolone acetonide (IVTA) and IVTA plus macular laser grid photocoagulation therapy in diffuse diabetic macular edema (DME). MATERIAL AND METHODS: Sixteen patients affected by diffuse DME were retrospectively evaulated. Patients were divided into two groups: control group (IVTA injection) and laser group (IVTA plus grid laser). Main outcomes were best corrected visual aquity (BCVA) and central macular thickness (CMT) at the 3(rd) and 6(th) months of treatment. IVTA associated complications and reinjection necessity were assessed. RESULTS: Our study comprised 18 eyes of 16 patients. The baseline BCVA and CMT were 0.93±0.45 and 530±136µm for the control and 1.02±0.52 and 509±177µm for the laser group respectively. Posttreatment BCVA at the 3(rd) and 6(th) month were 0.73±0.4 and 0.75±0.45 for control and 0.98±0.44 and 1.04±0.4 for laser group respectively (p>0.05 for all). CMT values at the 3(rd) and 6(th) months were 260±174µm (p=0.008) and 362±163 µm (p=0.05) for control and 331±161µm (p=0.05) and 388±215 µm (p>0.05) for laser groups. 55% of control and 66% of laser groups needed reinjection with an avarage of 7±4 months after the first injection. 22% cataract progression and 33% intraocular pressure elevation were noted. CONCLUSION: Macular grid laser photocoagulation after IVTA does not have beneficial effects for diffuse DME.

High-density silicone oil as an intraocular tamponade in complex retinal detachments.

OBJECTIVE: To evaluate the efficacy and safety of high-density silicone oil (HDSO) as an internal retinal tamponade after vitrectomy for complicated retinal detachment. DESIGN: Retrospective, non-randomized study. PARTICIPANTS: Forty-one eyes of 41 patients who were 5-73 years of age. METHODS: Medical records of patients with retinal detachment (RD) complicated with inferior proliferative vitreoretinopathy (PVR) requiring internal tamponade with HDSO were reviewed. Eyes with retinal vascular diseases and inflammatory diseases were excluded from the study. Follow-up examinations were scheduled at 1 week and 1, 3, 6, and 12 months after the initial surgery. RESULTS: Median value of follow-up was 8 months (range, 3-40 months). Twenty-five patients had rhegmatogenous RD with significant PVR and the remaining patients had complicated RD secondary to trauma. Preoperative visual acuity was 2.55 ± 0.75 logMAR, which became 1.89 ± 0.91 at the last follow-up visit (p < 0.05). Complications included increased intraocular pressure (9.7%), hypotony (2.4%), cataract (57.1%), silicone oil in anterior chamber (17%), persistent total corneal edema (7.3%), band keratopathy (7.3%), and significant inflammation (2.4%). Intraretinal or subretinal fibrosis was found in 12 eyes (29.2%). HDSO removal was performed after a mean period of 5.7 months (range, 3-34 months) in 34 patients. The anatomical success was 87.8%. CONCLUSIONS: The high anatomical success rate of 87.8% is a satisfactory result for these complicated RD cases. Subretinal proliferations and early emulsification limit the results. Further studies, with longer follow-ups and more patients, are needed to be conclusive.

Comparison of antifungal efficacies of moxifloxacin, liposomal amphotericin B, and combination treatment in experimental Candida albicans endophthalmitis in rabbits.

The goal of this study was to compare in vitro and in vivo efficacy of moxifloxacin and liposomal amphotericin B (Amp-B) monotherapies and combination treatment against Candida albicans in an exogenous endophthalmitis model in rabbit eyes. Microplate dilution tests and checkerboard analysis were performed to detect in vitro efficacies. Endophthalmitis was induced by intravitreal injection of C. albicans in 40 rabbit eyes with simultaneous intravitreal drug injection according to prophylactic treatment groups. Group 1 (control group) received 0.1 mL of balanced salt solution, group 2 (moxi group) 100 microg moxifloxacin/0.1 mL, group 3 (Amp-B group) 10 microg liposomal Amp-B/0.1 mL, and group 4 (combi group) both 100 microg moxifloxacin/0.1 mL [DOSAGE ERROR CORRECTED] and 10 microg liposomal Amp-B/0.05 mL intravitreally. Clinical examination, quantitative analysis of microorganisms, and histopathologic examination were performed as in vivo studies. The minimum inhibitory concentration of liposomal Amp-B against C. albicans was found to be 1 microg/mL. Moxifloxacin showed no inhibition of in vitro C. albicans growth. The minimum inhibitory concentration values of liposomal Amp-B for C. albicans were reduced two- to eightfold with increasing concentrations of moxifloxacin in vitro. In vivo, there was no C. albicans growth in the combi group (zero of eight eyes), whereas three eyes (37.5%) showed growth in the Amp-B group. Vitreous inflammation, retinal detachment, focal retinal necrosis, and outer nuclear layer loss were found to be lower in the moxi group compared with the control group. Ganglion cell and inner nuclear layer loss was observed in all eyes (100%) in both the moxi and combi groups, whereas only in 25% (two of eight eyes) in the Amp-B group. Moxifloxacin strongly augments the efficacy of liposomal Amp-B against C. albicans in vitro, although it has no in vitro antifungal activity when used alone. It is interesting that we found a synergistic effect for in vitro tests but failed to demonstrate it in vivo. When 100 microg moxifloxacin/0.1 mL is given intravitreally, it has some toxic effects that are limited to the inner retinal layers.