Department of Ophthalmology, Caritas Medical Centre, Hong Kong, China.
J Ocul Pharmacol Ther. 2011 Aug;27(4):411-3. doi: 10.1089/jop.2010.0163. Epub 2011 Jun 24.
To report a case of acute renal failure after topical fortified gentamicin and vancomycin eyedrops in the treatment of endophthalmitis.
A 67-year-old lady with diabetes mellitus was treated for bleb-related endophthalmitis. After intravitreal antibiotics, she was given oral ciprofloxacin, fortified gentamicin, and vancomycin eyedrops. She developed acute renal failure a few days after therapy. Blood tests and ultrasound of the urinary system were performed to investigate for the cause of the renal failure.
No apparent cause of renal failure could be identified in our patient. Autoimmune markers and ultrasound of the urinary system were unremarkable. Fortified gentamicin and vancomycin eyedrops were stopped on day 9 and 13, respectively. The renal function recovered dramatically. The gentamicin level was checked 2 days after it had been stopped, and the serum level was 0.34 mg/L. Renal function improved on supportive management without dialysis. Serum creatinine level completely normalized 2 months later.
This is the first article that demonstrated a detectable level of serum gentamicin level after usage of topical eyedrops. This is also the first article demonstrating that nephrotoxicity of topical fortified gentamicin and vancomycin eyedrops was found. The acute renal failure in our patient recovered completely after cessation of the eyedrops.
报告 1 例局部强化庆大霉素和万古霉素滴眼液治疗眼内炎后发生急性肾衰竭的病例。
一位 67 岁患有糖尿病的女士因眼内压治疗相关眼内炎接受治疗。在给予眼内注射抗生素后，她还口服环丙沙星、强化庆大霉素和万古霉素滴眼液。治疗几天后，她出现急性肾衰竭。进行了血液检查和泌尿系统超声检查以寻找肾衰竭的原因。
在我们的患者中，未能确定明显的肾衰竭原因。自身免疫标志物和泌尿系统超声检查均无明显异常。分别在第 9 天和第 13 天停用强化庆大霉素和万古霉素滴眼液。肾功能显著恢复。停药后 2 天检查了庆大霉素水平，血清水平为 0.34mg/L。在没有透析的支持治疗下，肾功能得到改善。2 个月后血肌酐水平完全正常。
这是第一篇报道局部滴眼后可检测到血清庆大霉素水平的文章。这也是第一篇报道局部强化庆大霉素和万古霉素滴眼液具有肾毒性的文章。我们的患者在停止使用滴眼液后，急性肾衰竭完全恢复。
