Murphy Conor C, Nicholson Steven, Quah Say Aun, Batterbury Mark, Neal Timothy, Kaye Stephen B
St Paul's Eye Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK.
Br J Ophthalmol. 2007 Oct;91(10):1350-3. doi: 10.1136/bjo.2006.112060. Epub 2007 Mar 27.
To determine the elimination kinetics of intracameral vancomycin administered as a bolus injection at the end of phacoemulsification cataract surgery.
Vancomycin 1 mg/0.1 ml saline solution was administered to 19 patients by intracameral bolus injection at the end of routine cataract surgery. The aqueous concentration of vancomycin was determined in nine patients 1 minute after administration and in 10 patients 18-24 hours postoperatively. Aqueous samples were obtained by inserting a Rycroft cannula into the anterior chamber via the side port incision. Fluorescence polarisation immunoassay was used to calculate the aqueous vancomycin concentration.
The median (interquartile range) vancomycin concentration was 5458 (4756-6389) mg/l at 1 minute and 40.6 (25.9-47.1) mg/l 18 to 24 hours (median 19 hours) postoperatively. The vancomycin concentration exceeded the minimum inhibitory concentration (MIC) of endophthalmitis-causing gram-positive bacteria by a factor of 4 for up to 26 hours postoperatively. No adverse event or reaction was noted.
Following bolus intracameral injection at the end of cataract surgery the concentration of vancomycin in the anterior chamber vastly exceeds its MIC for at least 24 hours but is predicted to fall below the MIC after 33 hours.
确定在白内障超声乳化手术结束时一次性注射前房万古霉素后的消除动力学。
在常规白内障手术结束时，对19例患者进行前房一次性注射1 mg/0.1 ml的万古霉素生理盐水溶液。在给药1分钟后对9例患者以及术后18 - 24小时（中位时间19小时）对10例患者测定前房内万古霉素浓度。通过侧切口将Rycroft套管插入前房获取房水样本。采用荧光偏振免疫分析法计算房水万古霉素浓度。
术后1分钟时万古霉素浓度中位数（四分位间距）为5458（4756 - 6389）mg/l，术后18至24小时（中位时间19小时）为40.6（25.9 - 47.1）mg/l。术后长达26小时，万古霉素浓度超过引起眼内炎的革兰氏阳性菌的最低抑菌浓度（MIC）达4倍。未观察到不良事件或反应。
白内障手术结束时进行前房一次性注射后，前房内万古霉素浓度至少在24小时内大幅超过其MIC，但预计33小时后会降至MIC以下。
