?AlM:To determine whether inferior injections had a higher incidence of post-injection endophthalmitis than superior injections. The incidence of endophthalmitis is higher for inferior than superior trabeculectomy filtering blebs, possibly due to bacteria pooling in the inferior tear lake.
? METHODS: A practice - wide database of endophthalmitis cases identified 5 occurring during the two-year study period. A retrospective review of 8 672 injections in 1 121 eyes of 909 patients treated during the same two-year study period was performed in order to assess the injection site location.
?RESULTS: Five eyes developed presumed infectious endophthalmitis. Eighty percent of endophthalmitis cases were injected inferiorly, even though 84. 6% of the total cohort was injected superiorly. The odds ratio of infection associated with inferior injection location is 22. 1 (P=0. 006).
? CONCLUSlON: Endophthalmitis after intravitreal injection is rare, occurring in only 0. 025% of injections overall. Avoiding intravitreal injections in the inferior quadrants may further reduce the rate of endophthalmitis.

Microdialysis is a technique used to measure the unbound antibiotic concentration in the interstitial spaces, the target site of action. In vitro recovery studies are essential to calibrating the microdialysis system for in vivo studies. The effect of a combination of antibiotics on recovery into microdialysate requires investigation. In vitro microdialysis recovery studies were conducted on a combination of vancomycin and tobramycin, in a simulated in vivo model. Comparison was made between recoveries for three different concentrations and three different perfusate flow rates. The overall relative recovery for vancomycinwas lower than that of tobramycin. For tobramycin, a concentration of 20μg/mL and flow rate of 1.0μL/min had the best recovery. A concentration of 5.0μg/mL and flow rate of 1.0μL/min yielded maximal recovery for vancomycin. Large molecular size and higher protein binding resulted in lower relative recoveries for vancomycin. Perfusate flow rates and drug concentrations affected the relative recovery when a combination of vancomycin and tobramycin was tested. Low perfusate flow rates were associated with higher recovery rates. For combination antibiotic measurement which includes agents that are highly protein bound, in vitro studies performed prior to in vivo studies may ensure the reliable measurement of unbound concentrations.

Aspergillus fumigatus sensitization and culture in asthma are associated with disease severity and lung function impairment, but their relationship with airway inflammation is poorly understood. We investigated the profile of 24 sputum inflammatory mediators in A. fumigatus culture-positive or-negative moderate-to-severe asthmatics. Fifty-two subjects were recruited from a single center. A. fumigatus was cultured from 19 asthmatics. Asthma control, symptom score, lung function, and sputum cell count were not significantly different between the asthmatics with and without a positive A. fumigatus culture. All of the sputum mediators were numerically increased in subjects with a positive versus negative sputum A. fumigatus culture. Sputum TNF-R2 was significantly elevated (P=0.03) and the mediator that best distinguished A. fumigatus culture-positive from culture-negative subjects (receiver-operator characteristic area under the curve 0.66 [95% CI: 0.51 to 0.82, P=0.045]). A. fumigates-positive culture in moderate-to-severe asthma is associated with increased inflammatory sputum mediators.
Aspergillus fumigatus* ; Aspergillus* ; Asthma ; Cell Count ; Inflammation ; Lung ; Receptors, Tumor Necrosis Factor, Type II ; Sputum*