Intravitreal dexamethasone as adjuvant in the treatment of postoperative endophthalmitis: a prospective randomized trial

  • Ivan M. Gan
  • Luana C. Ugahary
  • Jaap T. van Dissel
  • Eric Feron
  • Ed Peperkamp
  • Marc Veckeneer
  • Paul G. H. Mulder
  • Gert Jan Platenkamp
  • Jan C. van Meurs
Clinical Investigation



To study whether intravitreal dexamethasone as adjuvant to intravitreal antibiotics improves the outcome in patients with suspected postoperative bacterial endophthalmitis.


Prospective randomized clinical trial.


Tertiary referral center.

Patient population

Twenty-nine consecutive patients with suspected postoperative bacterial endophthalmitis within 6 weeks of cataract surgery.


Patients underwent a vitreous biopsy followed by intravitreal injection of antibiotics (0.2 mg vancomycin and 0.05 mg gentamicin) and 400 μg dexamethasone or placebo. After 3–4 days the intravitreal injection of antibiotics and dexamethasone or placebo was repeated

Primary outcome measure

Snellen visual acuity at 3 and 12 months after treatment.


In 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).


This 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.


Endophthalmitis Dexamethasone Adjuvant 



We gratefully acknowledge the help of Diane A.E. Mertens, Peter J. Ringens, vitreoretinal surgeons and Jan Jansen, Westblaak Pharmacy, Rotterdam.


  1. 1.
    Callegan MC, Engelbert M, Parke DW, Jett BD, Gilmore MS (2002) Bacterial endophthalmitis: epidemiology, therapeutics, and bacterium-host interactions. Clin Microbiol Rev 15(1):111–124CrossRefPubMedGoogle Scholar
  2. 2.
    Campochiaro PA, Conway BP (1991) Aminoglycoside toxicity–a survey of retinal specialists. Implications for ocular use. Arch Ophthalmol 109(7):946–950PubMedGoogle Scholar
  3. 3.
    Das T, Jalali S, Gothwal VK, Sharma S, Naduvilath TJ (1999) Intravitreal dexamethasone in exogenous bacterial endophthalmitis: results of a prospective randomised study. Br J Ophthalmol 83(9):1050–1055PubMedCrossRefGoogle Scholar
  4. 4.
    de Gans J, van de Beek, BD (2002) Dexamethasone in adults with bacterial meningitis. N Engl J Med 347(20):1549–1556CrossRefPubMedGoogle Scholar
  5. 5.
    Doft BM, Kelsey SF, Wisniewski SR (2000) Retinal detachment in the endophthalmitis vitrectomy study. Arch Ophthalmol 118(12):1661–1665PubMedGoogle Scholar
  6. 6.
    Endophthalmitis Vitrectomy Study Group (1995) Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Endophthalmitis Vitrectomy Study Group. Arch Ophthalmol 113(12):1479–1496Google Scholar
  7. 7.
    Endophthalmitis Vitrectomy Study Group (1996) Microbiologic factors and visual outcome in the endophthalmitis vitrectomy study. Am J Ophthalmol 122(6):830–846Google Scholar
  8. 8.
    Gan IM, Ugahary LC, van Dissel JT, Van Meurs JC (2005) Effect of intravitreal dexamethasone on vitreous vancomycin concentrations in patients with suspected postoperative bacterial endophthalmitis. Graefe's Arch Clin Exp Ophthalmol (in press)Google Scholar
  9. 9.
    Gan IM, van Dissel JT, Beekhuis WH, Swart W, Van Meurs JC (2001) Intravitreal vancomycin and gentamicin concentrations in patients with postoperative endophthalmitis. Br J Ophthalmol 85(11):1289–1293CrossRefPubMedGoogle Scholar
  10. 10.
    Hida T, Chandler D, Arena JE, Machemer R (1986) Experimental and clinical observations of the intraocular toxicity of commercial corticosteroid preparations. Am J Ophthalmol 101(2):190–195PubMedGoogle Scholar
  11. 11.
    Jett BD, Jensen HG, Atkuri RV, Gilmore MS (1995) Evaluation of therapeutic measures for treating endophthalmitis caused by isogenic toxin-producing and toxin-nonproducing Enterococcus faecalis strains. Invest Ophthalmol Vis Sci 36(1):9–15PubMedGoogle Scholar
  12. 12.
    Kwak HW, D'Amico DJ (1992) Evaluation of the retinal toxicity and pharmacokinetics of dexamethasone after intravitreal injection. Arch Ophthalmol 110(2):259–266PubMedGoogle Scholar
  13. 13.
    Maxwell DP Jr, Brent BD, Diamond JG, Wu L (1991) Effect of intravitreal dexamethasone on ocular histopathology in a rabbit model of endophthalmitis. Ophthalmology 98(9):1370–1375PubMedGoogle Scholar
  14. 14.
    McIntyre PB, Berkey CS, King SM, Schaad UB, Kilpi T, Kanra GY, Perez CM (1997) Dexamethasone as adjunctive therapy in bacterial meningitis. A meta-analysis of randomized clinical trials since 1988. JAMA 278(11):925–931CrossRefPubMedGoogle Scholar
  15. 15.
    Meredith TA, Aguilar HE, Drews C, Sawant A, Gardner S, Wilson LA, Grossniklaus HE (1996) Intraocular dexamethasone produces a harmful effect on treatment of experimental Staphylococcus aureus endophthalmitis. Trans Am Ophthalmol Soc 94:241–252PubMedGoogle Scholar
  16. 16.
    Meredith TA, Trabelsi A, Miller MJ, Aguilar E, Wilson LA (1990) Spontaneous sterilization in experimental Staphylococcus epidermidis endophthalmitis. Invest Ophthalmol Vis Sci 31(1):181–186PubMedGoogle Scholar
  17. 17.
    Shah GK, Stein JD, Sharma S, Sivalingam A, Benson WE, Regillo CD, Brown GC, Tasman W (2000) Visual outcomes following the use of intravitreal steroids in the treatment of postoperative endophthalmitis. Ophthalmology 107(3):486–489CrossRefPubMedGoogle Scholar
  18. 18.
    Tsang KW, Chan WM, Ho PL, Chan K, Lam WK, Ip MS (1999) A comparative study on the efficacy of levofloxacin and ceftazidime in acute exacerbation of bronchiectasis. Eur Respir J 14(5):1206–1209CrossRefPubMedGoogle Scholar
  19. 19.
    van de Beek, BD, de Gans J, McIntyre P, Prasad K (2003) Corticosteroids in acute bacterial meningitis. Cochrane Database Syst Rev (3):CD004305Google Scholar
  20. 20.
    Weijtens O, Schoemaker RC, Cohen AF, Romijn FP, Lentjes EG, van Rooij J, Van Meurs JC (1998) Dexamethasone concentration in vitreous and serum after oral administration. Am J Ophthalmol 125(5):673–679CrossRefPubMedGoogle Scholar
  21. 21.
    Weijtens O, van der Sluijs FA, Schoemaker RC, Lentjes EG, Cohen AF, Romijn FP, Van Meurs JC (1997) Peribulbar corticosteroid injection: vitreal and serum concentrations after dexamethasone disodium phosphate injection. Am J Ophthalmol 123(3):358–363PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Ivan M. Gan
    • 1
  • Luana C. Ugahary
    • 1
  • Jaap T. van Dissel
    • 2
  • Eric Feron
    • 1
  • Ed Peperkamp
    • 1
  • Marc Veckeneer
    • 1
  • Paul G. H. Mulder
    • 3
  • Gert Jan Platenkamp
    • 4
  • Jan C. van Meurs
    • 1
  1. 1.The Rotterdam Eye HospitalRotterdamThe Netherlands
  2. 2.Department of Infectious DiseasesUniversity of Leiden Medical CenterLeidenThe Netherlands
  3. 3.Department of Epidemiology & BiostatisticsErasmus University Medical Center RotterdamRotterdamThe Netherlands
  4. 4.Regional Medical Microbiological LaboratoryRotterdamThe Netherlands

Personalised recommendations