Aminoglycoside Toxicity in the Treatment of Endophthalmitis

The article on aminoglycoside toxicity by Campochiaro et al 1 in theArchivespurports to show 13 cases of toxic reaction to aminoglycoside that occurred with recommended doses of gentamicin sulfate and amikacin sulfate. What the article does show is 13 cases of macular ischemia following treatment for possible endophthalmitis. As discussed by Doft and Barza 2 for the Endophthalmitis Vitrectomy Study Group in the same issue, macular ischemia can be caused by the infection itself, incorrect dosage of antibiotics, retrobulbar injections, or drug interactions. In the article by Campochiaro and associates, no mention is made of the possibility that retrobulbar complications can give a similar fundus appearance. It was particularly disingenuous of the authors to include the reference from Judson, 3 which purported to show toxic reaction to tobramycin following a subconjunctival injection. Subsequent correspondence about that report, which was reviewed and published, raised questions as to the cause