Effect of an adjunctive first-line intravitreal betamethasone injection in postoperative endophthalmitis

Abstract

Purpose: To evaluate the effect of an adjunctive first-line intravitreal betamethasone injection in the treatment of acute postoperative endophthalmitis.

Methods: This was a prospective, single masked, multi center study involving 6 University Hospitals. Patients with acute endophthalmitis were included. On admission, patients received intravitreal vancomycin and ceftazidime associated with an intravitreal bethamethasone injection (IVB group) or not (no-IVB group). At 48 hours, all patients received another intravitreal antibiotic injection with betamethasone. In case of severe presentation at baseline or in case of deterioration a prompt or delayed vitrectomy was carried out. The primary endpoint was the proportion of patients achieving 20/40 at 12 months. The secondary endpoints were the rate of delayed vitrectomy and of retinal detachment

Results: Seventy six eyes of 76 patients were included. 40 patients were in the no-IVB group and 36 patients were in the IVB group. There was no statistical significant difference for the proportion of patients achieving 20/40 in both groups (P=0.49). In the subgroups of patients with light perception only at baseline and of patients with a baseline visual acuity at least equal to hand motion, there was no statistical difference for the proportion of patients achieving 20/40 (P=0.68 and P=0.88 respectively). The rate of retinal detachment and of delayed vitrectomy were not significantly different in both groups (P=0.36 and P=0.5 respectively).

Conclusions: A first-line adjunctive intravitreal betamethasone injection does not worsen the visual prognosis of acute postoperative endophthalmitis compared with a delayed injection.

Keywords: 513 endophthalmitis • 445 cataract • 487 corticosteroids