title: Early versus delayed intravitreal betamethasone as an adjuvant in the treatment of presumed postoperative endophthalmitis: a randomised trial.
abstract: OBJECTIVE
  To compare early versus delayed intravitreal betamethasone as an adjuvant in the treatment of presumed acute postoperative endophthalmitis after phacoemulsification.
  
  
  METHODS
  Patients with presumed postcataract surgery endophthalmitis were included in this prospective, randomised, multicentre study. On admission, patients received intravitreal vancomycin and ceftazidime, and were randomly assigned to intravitreal betamethasone injection (early-IVB) group or no immediate injection (delayed-IVB) group. After 48 h, a second intravitreal antibiotic injection associated with intravitreal betamethasone was given to all patients. In patients with severe endophthalmitis or clinical deterioration, a prompt or delayed vitrectomy was performed. The primary outcome was the proportion of patients achieving a visual acuity (VA) of 20/40 or better at 12 months. The secondary outcomes were the rate of delayed vitrectomy and the rate of complications (retinal detachment and phthisis).
  
  
  RESULTS
  Ninety-seven eyes of 97 patients were included, 45 in the early-IVB group and 52 in the delayed-IVB group. Overall, 62.9% of patients achieved a VA ≥20/40 at 1 year. There was no statistically significant difference in the visual outcome between the two groups at 1 year, whatever their baseline VA or light perception or hand motion or more (p=0.55 and p=0.10, respectively). The rates of delayed vitrectomy, retinal detachment and phthisis bulbi were not significantly different between the two groups (p=0.42, p=0.37 and p=0.44, respectively).
  
  
  CONCLUSIONS
  Early intravitreal betamethasone had no clear advantage versus delayed injection in the management of presumed postoperative endophthalmitis.
authors.affiliation: Department of Ophthalmology, University Hospital, Dijon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Koehrer
authors.affiliation: Department of Ophthalmology, University Hospital, Dijon, France Eye and Nutrition Research Group, CSGA, UMR1324 INRA, 6265 CNRS, Burgundy University, Dijon, France.
authors.forename: Alain M
authors.initials: AM
authors.lastname: Bron
authors.affiliation: Department of Ophthalmology, University Hospital, Grenoble, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Chiquet
authors.affiliation: Department of Ophthalmology, University Hospital, Saint-Etienne, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Thuret
authors.affiliation: Department of Ophthalmology, University Hospital, Besançon, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Delbosc
authors.affiliation: Department of Ophthalmology, University Hospital, Nancy, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Berrod
authors.affiliation: Department of Ophthalmology, University Hospital, Strasbourg, France.
authors.forename: Tristan
authors.initials: T
authors.lastname: Bourcier
authors.affiliation: Department of Ophthalmology, University Hospital, Strasbourg, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Sauer
authors.affiliation: Department of Clinical Research, University Hospital, Dijon, France.
authors.forename: Lysiane
authors.initials: L
authors.lastname: Jonval
authors.affiliation: Department of Clinical Research, University Hospital, Dijon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: D'Athis
authors.affiliation: Department of Ophthalmology, University Hospital, Dijon, France Eye and Nutrition Research Group, CSGA, UMR1324 INRA, 6265 CNRS, Burgundy University, Dijon, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Creuzot-Garcher
mesh_terms: D001623:Betamethasone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D009877:Endophthalmitis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D058449:Intravitreal Injections; D018918:Phacoemulsification / Q000009:adverse effects*; D011183:Postoperative Complications; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*
chemical_list: D005938:Glucocorticoids; D001623:Betamethasone
keywords: Clinical Trial; Infection