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Adjunctive use of intravitreal dexamethasone in presumed bacterial endophthalmitis: a randomised trial
  1. E Albrecht1,
  2. J C Richards2,
  3. T Pollock3,
  4. C Cook,
  5. L Myers1
  1. 1University of Cape Town Groote Schuur Hospital, Cape Town, South Africa
  2. 2Royal Perth Hospital, Perth, Western Australia, Australia
  3. 3Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
  1. Correspondence to Dr Eric Albrecht, Department of Ophthalmology, University of Cape Town, Ward D4, Groote Schuur Hospital, 13 East Light Way, Kirstenhof 7945, Cape Town, South Africa; albrecht{at}telkomsa.net

Abstract

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.

  • Endophthalmitis
  • intravitreal dexamethasone
  • intravitreal steroid
  • posterior chamber
  • vitreous
  • infection
  • clinical trial

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Footnotes

  • Competing interests None to declare.

  • Patient consent Obtained.

  • Ethics approval Approval from the University Of Cape Town Research Ethics Committee, Faculty of Medicine, was formally granted on 9 February 2001, REC REF: 226/2000.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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