Intravitreal corticosteroids as first-line adjunctive treatment in acute post cataract surgery endophthalmitis

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Abstract

Purpose

To assess the effect of intravitreal corticosteroids as first-line adjunctive treatment in acute post cataract surgery endophthalmitis.

Methods

We conducted a multicenter prospective, randomized, single-masked study including patients with acute post cataract surgery endophthalmitis. All patients received the initial intravitreal antibiotics (vancomycine 1mg, ceftazidime 2mg) with intravitreal betamethasone (400 μg) in the group 1 but not in the group 2. At day 2, all patients had the same invitreal antibiotics with betamethasone (400 μg). A prompt or deferred vitrectomy could be associated with this treatment if baseline visual acuity was limited to light perception. The primary endpoint was the BCVA (logMAR) and the secondary endpoint was the impact on intraocular pressure

Results

We report the preliminary results on the first 54 patients;. 24 patients were included in the group 1 and 30 in the group 2. The BCVA was better in the group 1 at 8 days (1.44 ± 0.90 vs 1.90 ± 1.0 logMAR), at one month (0.50 ± 0.69 vs 1.24 ± 1.11 logMAR) and at 3 months (0.52 ± 0.87 vs 0.99 ± 1.13 logMAR). The confidence intervals were overlapping, except at one month, suggesting a statistical significance at this point. There was no difference in both groups considering the intraocular pressure at day 8: 14.13 mmHg (IC 95%: 10.29-17.97) in the group 1 and 12.52 mmHg (IC 95%: 10.49-14.55) in the group 2.

Conclusion

Intravitreal corticosteroids as a first line adjunctive treatment in acute post cataract surgery endophthalmitis seem to accelerate the recovery of visual acuity but do not seem to have an impact on the final functional outcome. These results need to be confirmed by the statistical analysis of the cohort of 100 cases.

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