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No visual acuity improvement seen with dexamethasone in bacterial endophthalmitis after cataract surgery
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Patients with suspected bacterial endophthalmitis after cataract surgery showed no visual acuity improvement with intravitreal dexamethasone in addition to intravitreal antibiotics, according to a study.
The prospective, multicenter, randomized, placebo-controlled trial of 167 patients found that final best corrected visual acuity did not differ between patients who received dexamethasone and those who received a placebo. Patients were studied in three locations in the Netherlands: University Medical Centre Utrecht, Radboud University Nijmegen Medical Centre and Rotterdam Eye Hospital.
A vitreous diagnostic biopsy was performed on all patients, who then received an intravitreal injection of 0.2 mg vancomycin and 0.05 mg gentamicin, followed by 400 µg dexamethasone sodium diphosphate or placebo.
The injections were then repeated once within 3 to 4 days, and complete ophthalmic examinations took place at 4 weeks, 10 weeks, 6 months and 12 months.
There was no significant difference in final BCVA between the dexamethasone group (logMAR 0.31 ± 0.58) and the placebo group (logMAR 0.27 ± 0.50).
“Our study establishes that the use of intravitreal dexamethasone without preservatives, as an adjuvant to intravitreal antibiotics, has no beneficial effect and should be abandoned,” the study authors wrote.
In addition, the authors suggested not using dexamethasone could eliminate a “potentially toxic agent” because the current off-label formulations of the drug “contain a toxic or near toxic content of parabens.” – by Rebecca L. Forand
Disclosures: The study authors report that the study was supported by the Research Foundation Rotterdam Eye Hospital and the Foundation Dutch Ophthalmological Research, solely to produce the study drug and placebo.
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