• Ivan M Gan, Luana C Ugahary, Jaap T van Dissel, Eric Feron, Ed Peperkamp, Marc Veckeneer, Paul G H Mulder, Gert Jan Platenkamp, and Jan C van Meurs.
• The Rotterdam Eye Hospital, The Netherlands.
• Graefes Arch. Clin. Exp. Ophthalmol. 2005 Dec 1;243(12):1200-5.

PurposeTo study whether intravitreal dexamethasone as adjuvant to intravitreal antibiotics improves the outcome in patients with suspected postoperative bacterial endophthalmitis.DesignProspective randomized clinical trial.SettingTertiary referral center.Patient PopulationTwenty-nine consecutive patients with suspected postoperative bacterial endophthalmitis within 6 weeks of cataract surgery.InterventionPatients 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 MeasureSnellen visual acuity at 3 and 12 months after treatment.ResultsIn 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).ConclusionThis 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.

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