The effect of a preoperative subconjuntival injection of dexamethasone on blood-retinal barrier breakdown following scleral buckling retinal detachment surgery: a prospective randomized placebo-controlled double blind clinical trial.
BACKGROUND
Blood-retinal barrier breakdown secondary to retinal detachment and retinal detachment repair is a factor in the pathogenesis of proliferative vitreoretinopathy (PVR). We wished to investigate whether an estimated 700 to 1000 ng/ml subretinal dexamethasone concentration at the time of surgery would decrease the blood-retinal barrier breakdown postoperatively.


METHODS
Prospective, placebo-controlled, double blind clinical trial. In 34 patients with rhegmatogenous retinal detachment scheduled for conventional scleral buckling retinal detachment surgery, a subconjunctival injection of 0.5 ml dexamethasone diphosphate (10 mg) or 0.5 ml placebo was given 5-6 hours before surgery. Differences in laser flare photometry (KOWA) measurements taken 1, 3 and 6 weeks after randomisation between dexamethasone and placebo were analysed using mixed model ANOVA, while correcting for the preoperative flare measurement.


RESULTS
Six patients did not complete the study, one because of recurrent detachment within 1 week, and five because they missed their postoperative laser flare visits. The use of dexamethasone resulted in a statistically significant decrease in laser flare measurements at the 1-week postoperative visit.


CONCLUSIONS
The use of a preoperative subconjunctival injection of dexamethasone decreased 1-week postoperative blood-retina barrier breakdown in patients undergoing conventional scleral buckling retinal detachment surgery. This steroid priming could be useful as a part of a peri-operative regime that would aim at decreasing the incidence of PVR.
Bali
Ernesto
E
The Rotterdam Eye Hospital, Rotterdam, The Netherlands.
Feron
Eric J
EJ
Peperkamp
Ed
E
Veckeneer
Marc
M
Mulder
Paul G
PG
van Meurs
Jan C
JC
D000293:Adolescent; D000328:Adult; D000368:Aged; D001813:Blood-Retinal Barrier / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D003131:Combined Modality Therapy; D003228:Conjunctiva; D003907:Dexamethasone / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D056965:Injections, Intraocular; D007834:Lasers; D008297:Male; D008875:Middle Aged; D010783:Photometry; D010919:Placebos; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D012162:Retinal Degeneration / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery; D012591:Scleral Buckling; D018630:Vitreoretinopathy, Proliferative / Q000517:prevention & control*; D055815:Young Adult
D005938:Glucocorticoids; D010919:Placebos; D003907:Dexamethasone