Intravitreal dexamethasone as adjuvant in the treatment of postoperative endophthalmitis: a prospective randomized trial

Ivan M Gan; Luana C Ugahary; Jaap T van Dissel; Eric Feron; Ed Peperkamp; Marc Veckeneer; Paul G H Mulder; Gert Jan Platenkamp; Jan C van Meurs

doi:10.1007/s00417-005-0133-1

Intravitreal dexamethasone as adjuvant in the treatment of postoperative endophthalmitis: a prospective randomized trial

Ivan M Gan, Luana C Ugahary, Jaap T van Dissel, Eric Feron, Ed Peperkamp, Marc Veckeneer, Paul G H Mulder, Gert Jan Platenkamp, Jan C van Meurs

Vitreoretinal surgery

Research output: Contribution to journal › Article › Research › peer-review

Abstract

PURPOSE: To study whether intravitreal dexamethasone as adjuvant to intravitreal antibiotics improves the outcome in patients with suspected postoperative bacterial endophthalmitis.

DESIGN: Prospective randomized clinical trial.

SETTING: Tertiary referral center.

PATIENT POPULATION: Twenty-nine consecutive patients with suspected postoperative bacterial endophthalmitis within 6 weeks of cataract surgery.

INTERVENTION: Patients underwent a vitreous biopsy followed by intravitreal injection of antibiotics (0.2 mg vancomycin and 0.05 mg gentamicin) and 400 microg dexamethasone or placebo. After 3-4 days the intravitreal injection of antibiotics and dexamethasone or placebo was repeated.

PRIMARY OUTCOME MEASURE: Snellen visual acuity at 3 and 12 months after treatment.

RESULTS: In 20/29 patients (69%) the vitreous cultures were positive. 13/29 patients received dexamethasone. Seven patients had a functionally lost eye (final vision of hand movements or less), in four due to retinal detachment. Visual acuity tended to be better in the dexamethasone treated patients than in those given placebo, at both 3 months (P=0.055) and 12 months (P=0.080).

CONCLUSION: This small prospective, placebo-controlled series showed a trend towards a better visual outcome in patients with suspected bacterial endophthalmitis when treatment with intravitreal antibiotics was combined with intravitreal dexamethasone. Our findings justify a larger multicenter randomized study.

Original language	English
Pages (from-to)	1200-5
Number of pages	6
Journal	Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie
Volume	243
Issue number	12
DOIs	https://doi.org/10.1007/s00417-005-0133-1
Publication status	Published - Dec 2005

Keywords

Aged
Aged, 80 and over
Anti-Bacterial Agents/therapeutic use
Biopsy
Cataract Extraction/adverse effects
Chemotherapy, Adjuvant
Dexamethasone/therapeutic use
Drug Therapy, Combination
Endophthalmitis/drug therapy
Eye Infections, Bacterial/drug therapy
Female
Follow-Up Studies
Gentamicins/therapeutic use
Glucocorticoids/therapeutic use
Humans
Injections
Male
Middle Aged
Postoperative Complications
Prospective Studies
Treatment Outcome
Vancomycin/therapeutic use
Vitreous Body/microbiology

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10.1007/s00417-005-0133-1

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Gan, I. M., Ugahary, L. C., van Dissel, J. T., Feron, E., Peperkamp, E., Veckeneer, M., Mulder, P. G. H., Platenkamp, G. J., & van Meurs, J. C. (2005). Intravitreal dexamethasone as adjuvant in the treatment of postoperative endophthalmitis: a prospective randomized trial. Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 243(12), 1200-5. https://doi.org/10.1007/s00417-005-0133-1

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title = "Intravitreal dexamethasone as adjuvant in the treatment of postoperative endophthalmitis: a prospective randomized trial",

abstract = "PURPOSE: To study whether intravitreal dexamethasone as adjuvant to intravitreal antibiotics improves the outcome in patients with suspected postoperative bacterial endophthalmitis.DESIGN: Prospective randomized clinical trial.SETTING: Tertiary referral center.PATIENT POPULATION: Twenty-nine consecutive patients with suspected postoperative bacterial endophthalmitis within 6 weeks of cataract surgery.INTERVENTION: Patients underwent a vitreous biopsy followed by intravitreal injection of antibiotics (0.2 mg vancomycin and 0.05 mg gentamicin) and 400 microg dexamethasone or placebo. After 3-4 days the intravitreal injection of antibiotics and dexamethasone or placebo was repeated.PRIMARY OUTCOME MEASURE: Snellen visual acuity at 3 and 12 months after treatment.RESULTS: In 20/29 patients (69%) the vitreous cultures were positive. 13/29 patients received dexamethasone. Seven patients had a functionally lost eye (final vision of hand movements or less), in four due to retinal detachment. Visual acuity tended to be better in the dexamethasone treated patients than in those given placebo, at both 3 months (P=0.055) and 12 months (P=0.080).CONCLUSION: This small prospective, placebo-controlled series showed a trend towards a better visual outcome in patients with suspected bacterial endophthalmitis when treatment with intravitreal antibiotics was combined with intravitreal dexamethasone. Our findings justify a larger multicenter randomized study.",

keywords = "Aged, Aged, 80 and over, Anti-Bacterial Agents/therapeutic use, Biopsy, Cataract Extraction/adverse effects, Chemotherapy, Adjuvant, Dexamethasone/therapeutic use, Drug Therapy, Combination, Endophthalmitis/drug therapy, Eye Infections, Bacterial/drug therapy, Female, Follow-Up Studies, Gentamicins/therapeutic use, Glucocorticoids/therapeutic use, Humans, Injections, Male, Middle Aged, Postoperative Complications, Prospective Studies, Treatment Outcome, Vancomycin/therapeutic use, Vitreous Body/microbiology",

author = "Gan, {Ivan M} and Ugahary, {Luana C} and {van Dissel}, {Jaap T} and Eric Feron and Ed Peperkamp and Marc Veckeneer and Mulder, {Paul G H} and Platenkamp, {Gert Jan} and {van Meurs}, {Jan C}",

year = "2005",

month = dec,

doi = "10.1007/s00417-005-0133-1",

language = "English",

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Gan, IM , Ugahary, LC, van Dissel, JT, Feron, E, Peperkamp, E, Veckeneer, M, Mulder, PGH, Platenkamp, GJ & van Meurs, JC 2005, 'Intravitreal dexamethasone as adjuvant in the treatment of postoperative endophthalmitis: a prospective randomized trial', Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, vol. 243, no. 12, pp. 1200-5. https://doi.org/10.1007/s00417-005-0133-1

Intravitreal dexamethasone as adjuvant in the treatment of postoperative endophthalmitis: a prospective randomized trial. / Gan, Ivan M ; Ugahary, Luana C; van Dissel, Jaap T et al.
In: Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, Vol. 243, No. 12, 12.2005, p. 1200-5.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - Intravitreal dexamethasone as adjuvant in the treatment of postoperative endophthalmitis

T2 - a prospective randomized trial

AU - Gan, Ivan M

AU - Ugahary, Luana C

AU - van Dissel, Jaap T

AU - Feron, Eric

AU - Peperkamp, Ed

AU - Veckeneer, Marc

AU - Mulder, Paul G H

AU - Platenkamp, Gert Jan

AU - van Meurs, Jan C

PY - 2005/12

Y1 - 2005/12

N2 - PURPOSE: To study whether intravitreal dexamethasone as adjuvant to intravitreal antibiotics improves the outcome in patients with suspected postoperative bacterial endophthalmitis.DESIGN: Prospective randomized clinical trial.SETTING: Tertiary referral center.PATIENT POPULATION: Twenty-nine consecutive patients with suspected postoperative bacterial endophthalmitis within 6 weeks of cataract surgery.INTERVENTION: Patients underwent a vitreous biopsy followed by intravitreal injection of antibiotics (0.2 mg vancomycin and 0.05 mg gentamicin) and 400 microg dexamethasone or placebo. After 3-4 days the intravitreal injection of antibiotics and dexamethasone or placebo was repeated.PRIMARY OUTCOME MEASURE: Snellen visual acuity at 3 and 12 months after treatment.RESULTS: In 20/29 patients (69%) the vitreous cultures were positive. 13/29 patients received dexamethasone. Seven patients had a functionally lost eye (final vision of hand movements or less), in four due to retinal detachment. Visual acuity tended to be better in the dexamethasone treated patients than in those given placebo, at both 3 months (P=0.055) and 12 months (P=0.080).CONCLUSION: This small prospective, placebo-controlled series showed a trend towards a better visual outcome in patients with suspected bacterial endophthalmitis when treatment with intravitreal antibiotics was combined with intravitreal dexamethasone. Our findings justify a larger multicenter randomized study.

AB - PURPOSE: To study whether intravitreal dexamethasone as adjuvant to intravitreal antibiotics improves the outcome in patients with suspected postoperative bacterial endophthalmitis.DESIGN: Prospective randomized clinical trial.SETTING: Tertiary referral center.PATIENT POPULATION: Twenty-nine consecutive patients with suspected postoperative bacterial endophthalmitis within 6 weeks of cataract surgery.INTERVENTION: Patients underwent a vitreous biopsy followed by intravitreal injection of antibiotics (0.2 mg vancomycin and 0.05 mg gentamicin) and 400 microg dexamethasone or placebo. After 3-4 days the intravitreal injection of antibiotics and dexamethasone or placebo was repeated.PRIMARY OUTCOME MEASURE: Snellen visual acuity at 3 and 12 months after treatment.RESULTS: In 20/29 patients (69%) the vitreous cultures were positive. 13/29 patients received dexamethasone. Seven patients had a functionally lost eye (final vision of hand movements or less), in four due to retinal detachment. Visual acuity tended to be better in the dexamethasone treated patients than in those given placebo, at both 3 months (P=0.055) and 12 months (P=0.080).CONCLUSION: This small prospective, placebo-controlled series showed a trend towards a better visual outcome in patients with suspected bacterial endophthalmitis when treatment with intravitreal antibiotics was combined with intravitreal dexamethasone. Our findings justify a larger multicenter randomized study.

KW - Aged

KW - Aged, 80 and over

KW - Anti-Bacterial Agents/therapeutic use

KW - Biopsy

KW - Cataract Extraction/adverse effects

KW - Chemotherapy, Adjuvant

KW - Dexamethasone/therapeutic use

KW - Drug Therapy, Combination

KW - Endophthalmitis/drug therapy

KW - Eye Infections, Bacterial/drug therapy

KW - Female

KW - Follow-Up Studies

KW - Gentamicins/therapeutic use

KW - Glucocorticoids/therapeutic use

KW - Humans

KW - Injections

KW - Male

KW - Middle Aged

KW - Postoperative Complications

KW - Prospective Studies

KW - Treatment Outcome

KW - Vancomycin/therapeutic use

KW - Vitreous Body/microbiology

U2 - 10.1007/s00417-005-0133-1

DO - 10.1007/s00417-005-0133-1

M3 - Article

C2 - 16235062

SN - 0721-832X

VL - 243

SP - 1200

EP - 1205

JO - Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie

JF - Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie

IS - 12

ER -

Gan IM , Ugahary LC, van Dissel JT, Feron E, Peperkamp E, Veckeneer M et al. Intravitreal dexamethasone as adjuvant in the treatment of postoperative endophthalmitis: a prospective randomized trial. Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie. 2005 Dec;243(12):1200-5. doi: 10.1007/s00417-005-0133-1

Intravitreal dexamethasone as adjuvant in the treatment of postoperative endophthalmitis: a prospective randomized trial

Abstract

Keywords

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