Adjunctive use of intravitreal dexamethasone in presumed bacterial
endophthalmitis: a randomised trial.
Author(s): Albrecht E, Richards JC, Pollock T, Cook C, Myers L.
Affiliation(s): University of Cape Town Groote Schuur Hospital, Cape Town, South Africa.
albrecht@telkomsa.net
Publication date & source: 2011, Br J Ophthalmol. , 95(10):1385-8
AIM: 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.
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