Presumed macular toxicity of intravitreal antibiotics.

Background: Intravitreal injection is the most effective route for administration of antibiotics in intraocular infections. Patients and Methods: Two patients presented with a metal foreign body in the central vitreous without damage to the retina. Results: Foreign bodies were removed with an intraocular magnet and limited vitrectomy was performed. Because of leukocytic infiltration of the vitreous, 1 mg vancomycin and 0.4 mg amikacin were injected in the vitreous at the end of the surgery. Postoperative visual acuity did not reach preoperative values in both patients. ERG examination revealed reduced photoreceptor activity. We speculate that amikacin may have reached the macula in a high and toxic concentration in an incompletely vitrectomized eye. Conclusion: The currently accepted intravitreal use of amikacin may cause retinal toxicity.