title: Adjunctive use of intravitreal dexamethasone in presumed bacterial endophthalmitis: a randomised trial.
abstract: OBJECTIVE
  To evaluate the use of intravitreal dexamethasone as adjunctive therapy in the treatment of presumed bacterial endophthalmitis. Design Prospective, double masked, randomised placebo-controlled clinical trial.
  
  
  METHODS
  Patients with 'post cataract surgery', 'bleb-related' and 'other' endophthalmitis were grouped and randomised to receive intravitreal ceftazidime (2.225 mg/0.1 ml), vancomycin (1 mg/0.1 ml), and either dexamethasone (0.4 mg/0.1) or placebo. All underwent vitreous and aqueous sampling for microbiological analysis. Injections were repeated after 48 h if necessary. The primary outcome measure was Snellen visual acuity on presentation, within the first 14 days post injection, and at 2-4 months.
  
  
  RESULTS
  62 patients completed the protocol from 2001 to 2005. Thirty patients received intravitreal dexamethasone and 32 received intravitreal placebo. There was no statistically significant difference in the visual outcomes of either group with a mean 2.79 Snellen lines improvement of the intravitreal dexamethasone group versus 1.8 lines in the placebo group. Subgroup analysis suggested a clinical trend to better visual acuity in the post cataract steroid subgroup with mean 4.1 lines improvement versus 2.7 in the placebo group (p=0.33). No adverse events attributable to the dexamethasone were reported.
  
  
  CONCLUSIONS
  Intravitreal dexamethasone appears safe and may be of benefit in post cataract surgery bacterial endophthalmitis.
authors.affiliation: University of Cape Town Groote Schuur Hospital, Cape Town, South Africa. albrecht@telkomsa.net
authors.forename: E
authors.initials: E
authors.lastname: Albrecht
authors.forename: J C
authors.initials: JC
authors.lastname: Richards
authors.forename: T
authors.initials: T
authors.lastname: Pollock
authors.forename: C
authors.initials: C
authors.lastname: Cook
authors.forename: L
authors.initials: L
authors.lastname: Myers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001082:Aqueous Humor / Q000382:microbiology; D001419:Bacteria / Q000302:isolation & purification; D002387:Cataract Extraction; D002442:Ceftazidime / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D005260:Female; D018463:Filtering Surgery; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014640:Vancomycin / Q000627:therapeutic use; D014792:Visual Acuity / Q000502:physiology; D014822:Vitreous Body / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D014640:Vancomycin; D003907:Dexamethasone; D002442:Ceftazidime