The treatment of many ocular disorders is hampered because of poor penetration of systemically administered drugs into the eye. The tight junctional complexes (zonulae occludens) of the
retinal pigment epithelium and
retinal capillaries are the site of the blood-ocular barrier. This barrier inhibits penetration of substances, including
antibiotics, into the vitreous. Over the last 18 years we have evaluated the nontoxic doses of various drugs. These include
antibiotics and antifungals for treatment of bacterial and fungal endophthalmitis, antivirals for treatment of viral
retinitis (specifically, when medication with these drugs poses the
threat of
toxicity to other organs). Intravitreal
antineoplastic drugs have been studied to prevent
cell proliferation in the
vitreous cavity after
retinal attachment
surgery, which can lead to
proliferative vitreoretinopathy (PVR). Furthermore, we evaluated the anti-inflammatory action of
dexamethasone and cyclosporine A to reduce intraocular
inflammation after
intraocular surgery or in
uveitis. Because these studies had been performed in the presence of the vitreous, which can slow down the
diffusion of the drugs toward the
retina, it was necessary to reevaluate the concentration of drugs which could be administered intravitreally in the vitrectomized eye. The nontoxic
dose of numerous drugs when added to
vitrectomy infusion fluid has also been evaluated. Furthermore, the role of
vitrectomy in the treatment of bacterial fungal endophthalmitis has been studied and the role of
vitrectomy in this ocular disorder is defined.