Role of intravitreal dexamethasone in exogenous fungal endophthalmitis.
OBJECTIVE
To determine the effects of intravitreal dexamethasone in patients with exogenous fungal endophthalmitis.


METHODS
Twenty cases of culture-proven exogenous fungal endophthalmitis following cataract surgery (11/20) and trauma (9/20) were retrospectively analysed for pre- and postoperative visual acuity, anterior chamber and vitreous inflammation and media clarity. All patients were managed with pars plana vitrectomy with intravitreal amphotericin B and oral ketoconazole with (steroid plus group) or without (steroid minus group) intravitreal dexamethasone. Results were analysed by Fisher's exact test.


RESULTS
Following vitrectomy 9 of 20 patients (45%) achieved a visual acuity better than counting fingers at 3 m. No statistically significant difference was observed in anatomical and visual outcome between the steroid plus and steroid minus groups, though the number of patients with favourable visual outcome was greater in the steroid plus group. Rate of clearance of inflammation was better in the steroid plus group (40 +/- 15.5 vs 55 +/- 8.6 days). All patients (6/20) with pre-operative vision better than counting fingers showed good anatomical and visual outcome in both groups.


CONCLUSIONS
The results of our retrospective study suggest that steroids may be beneficial in promoting faster clearance of inflammation in fungal endophthalmitis. Sensitivity of the fungi to antifungals, dose and timing of steroid and institution of effective antifungal medication prior to the use of steroids are the essential factors which need to be examined further in a prospective manner.
Majji
A B
AB
Retina Vitreous Services, L.V. Prasad Eye Institute, Hyderabad, India. ajit@lvpeye.stph.net
Jalali
S
S
Das
T
T
Gopinathan
U
U
D000287:Administration, Topical; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002387:Cataract Extraction; D003907:Dexamethasone / Q000627:therapeutic use*; D009877:Endophthalmitis / Q000188:drug therapy* / Q000209:etiology; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000209:etiology; D005131:Eye Injuries / Q000150:complications; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D003907:Dexamethasone