The role of intravitreal dexamethasone as an adjunct in the management of postoperative bacterial endophthalmitis

Objective: To evaluate the effect of adjunctive intravitreal dexamethasone administration on the visual outcomes of patients suffering from post-cataract extraction or secondary intracular lens (IOL) placement-related bacterial endophthalmitis. Methods: Consecutive records for all patients treated at the Medical College of Wisconsin from 1994-1998, with endophathalmitis after cataract surgery or secondary IOL placement with at least two months follow-up were retrospectively analyzed. Complete preoperative, intraoperative, and postoperative data was collected for each patient. Patient were stratified into two groups, one that received adjunctive dexamethasone during the initial endophthalmitis treatment, and one that did not. Patients receiving systemic corticosteroids were excluded to better isolate the effect of dexamethasone. Statistical analysis was performed to compare baseline characteristics and visual outcomes between the two groups. Logistics regression analysis was performed to identify factors associated with a difference in visual outcome attributable to dexamethasone. Results: 42 eyes of 42 patients were studied; 18 receiving dexamethasone, 24 not. Baseline characteristics were similar between the two groups. 78% of patients treated vs. 75% not treated with dexamethasone demonstrated visual improvement. Mean visual improvement was 1.02 LogMAR in those receiving dexamethasone, compared to 1.35 LogMAR in those not receiving it. A final vision of at least 20/40 was achieved in 54% vs. 56% of patients in these groups, respectively. None of these differences were significant. Regression analysis failed to identify any preoperative factors associated with a visual difference associated with dexamenthasone administration. Postoperative complications and needs for additional surgery were also similar between groups. Conclusions: The simultaneous administration of intravitreal de xamethasone with intravitreal antibiotics appears to result in no demonstrable additional visual benefit over standard antibiotics alone in the treatment of postoperative endophthalmitis.