Purchase this article with an account.
E.F. Hall, D. Musch, D. Zacks; Adjunctive Use of Intravitreal Steroid in the Treatment of Acute Post–Operative Endophthalmitis . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5554.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: To evaluate the role of intravitreal steroids (IVS) as an adjunctive treatment in cases of cataract surgery–related acute postoperative endophthalmitis. Methods: Charts of all consecutive patients treated for acute endophthalmitis following cataract surgery at the University of Michigan’s Kellogg Eye Center between July 1, 1995 and June 30, 2004 were retrospectively reviewed. All patients were treated with either: a) vitreous tap and injection of antibiotics or b) vitrectomy and intravitreal antibiotics. Patients were concomitantly treated with or without intravitreal dexamethasone (400ug/0.1mL), based on the preference of the treating physician. Age, sex, interval between procedure and diagnosis, baseline visual acuity, initial treatment modality, use of intravitreal steroid (IVS), infecting organism, length of follow–up, post–treatment final recorded visual acuity, and other post–treatment complications were recorded. A three–line improvement (or three–category improvement, for acuities such as light perception, hand motion and counting fingers) in visual acuity was utilized as a primary outcome measure. Results: 79 patients met our inclusion criteria, of which 27 received IVS at the time of treatment and 52 who did not. Baseline demographics of age and gender were the same between the two groups. Presenting visual acuity differed significantly between the two groups with only 63% of patients (17/27) at HM or better in the IVS group vs. 87% (45/52) in the non–IVS group (p=0.02). Also, a significantly higher percentage of patients in the IVS group were treated with vitrectomy (30% vs. 14%, p=0.004). Coagulase–negative Staphylococcus was the predominant infecting organism in both groups. We had a mean follow–up of 109 days in the IVS group and 104 days in the non–IVS group. The final mean visual acuity was 20/250 in the IVS group and 20/200 in the non–IVS group (p=0.68). Our primary outcome measure of a three–line (or category) improvement in visual acuity was observed in 74% (20/27) of patients in the IVS group and 73% (38/52) in the non–IVS group (p=0.92). Conclusions:There have been no prospective studies examining the role of IVS in the treatment of acute postoperative endophthalmitis, and previous retrospective studies have suggested a detrimental effect of IVS in this setting. The fact that those who received IVS had a poorer prognosis at the time of presentation and yet achieved the same degree of improvement in visual acuity is noteworthy, and suggests the need for further evaluative study of IVS use in endophthalmitis.
This PDF is available to Subscribers Only