Letter to the Editor: Comment on Upadhyaya et al.'s "Intravitreal Clindamycin as an Adjuvant Therapy in Congenital Toxoplasma Retinochoroiditis in a Neonate - A Case Report".

The novel work by Upadhyaya et al. suggests a potential use of intravitreal clindamycin for treating congenital toxoplasma retinochoroiditis. We share our clinical experience of encountering a sudden spike in intraocular pressure (IOP) after administering intravitreal clindamycin (5 mg/0.5 mL) in a neonate. Intravitreal injections are known to cause an increase in IOP immediately, which reduces in a few minutes. However, a smaller vitreous volume in neonates can cause an exponential increase in IOP immediately post-injection, posing a risk of optic nerve damage and compromise in retinal perfusion. We suggest modifying the intravitreal preparation of clindamycin to 0.5 mg/0.025 mL when used in neonates to reduce this risk while maintaining therapeutic efficacy.