Early versus delayed intravitreal betamethasone as an adjuvant in the treatment of presumed postoperative endophthalmitis: a randomised trial.

Abstract

AIM:

To compare early versus delayed intravitreal betamethasone as an adjuvant in the treatment of presumed acute postoperative endophthalmitis after phacoemulsification.

METHODS:

Patients with presumed postcataract surgery endophthalmitis were included in this prospective, randomised, multicentre study. On admission, patients received intravitreal vancomycin and ceftazidime, and were randomly assigned to intravitreal betamethasone injection (early-IVB) group or no immediate injection (delayed-IVB) group. After 48 h, a second intravitreal antibiotic injection associated with intravitreal betamethasone was given to all patients. In patients with severe endophthalmitis or clinical deterioration, a prompt or delayed vitrectomy was performed. The primary outcome was the proportion of patients achieving a visual acuity (VA) of 20/40 or better at 12 months. The secondary outcomes were the rate of delayed vitrectomy and the rate of complications (retinal detachment and phthisis).

RESULTS:

Ninety-seven eyes of 97 patients were included, 45 in the early-IVB group and 52 in the delayed-IVB group. Overall, 62.9% of patients achieved a VA ≥20/40 at 1 year. There was no statistically significant difference in the visual outcome between the two groups at 1 year, whatever their baseline VA or light perception or hand motion or more (p=0.55 and p=0.10, respectively). The rates of delayed vitrectomy, retinal detachment and phthisis bulbi were not significantly different between the two groups (p=0.42, p=0.37 and p=0.44, respectively).

CONCLUSIONS:

Early intravitreal betamethasone had no clear advantage versus delayed injection in the management of presumed postoperative endophthalmitis.

• Authors: Philippe Koehrer, Alain M Bron, Christophe Chiquet, Gilles Thuret, Bernard Delbosc, Jean-Paul Berrod, Tristan Bourcier, Arnaud Sauer, Lysiane Jonval, Philippe D'Athis, Catherine Creuzot-Garcher
• Journal: The British journal of ophthalmology (Br J Ophthalmol) Vol. 100 Issue 8 Pg. 1076-80 (Aug 2016) ISSN: 1468-2079 [Electronic] England
• PMID: 26603558 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Chemical References

• Glucocorticoids
• Betamethasone

Topics

• Betamethasone (administration & dosage)
• Dose-Response Relationship, Drug
• Endophthalmitis (diagnosis, etiology, therapy)
• Follow-Up Studies
• Glucocorticoids (administration & dosage)
• Intravitreal Injections
• Phacoemulsification (adverse effects)
• Postoperative Complications
• Prospective Studies
• Time Factors
• Treatment Outcome
• Visual Acuity
• Vitrectomy (methods)