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 -