Intravitreal dexamethasone as adjuvant in the treatment of postoperative endophthalmitis: a prospective randomized trial.
OBJECTIVE
To study whether intravitreal dexamethasone as adjuvant to intravitreal antibiotics improves the outcome in patients with suspected postoperative bacterial endophthalmitis.


METHODS
Prospective randomized clinical trial.


METHODS
Tertiary referral center.


METHODS
Twenty-nine consecutive patients with suspected postoperative bacterial endophthalmitis within 6 weeks of cataract surgery.


METHODS
Patients underwent a vitreous biopsy followed by intravitreal injection of antibiotics (0.2 mg vancomycin and 0.05 mg gentamicin) and 400 microg dexamethasone or placebo. After 3-4 days the intravitreal injection of antibiotics and dexamethasone or placebo was repeated.


METHODS
Snellen visual acuity at 3 and 12 months after treatment.


RESULTS
In 20/29 patients (69%) the vitreous cultures were positive. 13/29 patients received dexamethasone. Seven patients had a functionally lost eye (final vision of hand movements or less), in four due to retinal detachment. Visual acuity tended to be better in the dexamethasone treated patients than in those given placebo, at both 3 months (P=0.055) and 12 months (P=0.080).


CONCLUSIONS
This small prospective, placebo-controlled series showed a trend towards a better visual outcome in patients with suspected bacterial endophthalmitis when treatment with intravitreal antibiotics was combined with intravitreal dexamethasone. Our findings justify a larger multicenter randomized study.
Gan
Ivan M
IM
The Rotterdam Eye Hospital, The Netherlands.
Ugahary
Luana C
LC
van Dissel
Jaap T
JT
Feron
Eric
E
Peperkamp
Ed
E
Veckeneer
Marc
M
Mulder
Paul G H
PG
Platenkamp
Gert Jan
GJ
van Meurs
Jan C
JC
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001706:Biopsy; D002387:Cataract Extraction / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant; D003907:Dexamethasone / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000188:drug therapy* / Q000209:etiology; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005839:Gentamicins / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use; D014822:Vitreous Body / Q000382:microbiology
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D005938:Glucocorticoids; D014640:Vancomycin; D003907:Dexamethasone