Effect of intravitreal dexamethasone on vitreous vancomycin concentrations in patients with suspected postoperative bacterial endophthalmitis

  • Ivan M. Gan
  • Luana C. Ugahary
  • Jaap T. van Dissel
  • Jan C. van Meurs
Short Communication



To study intravitreal dexamethasone and vancomycin concentrations, when used together in patients with suspected postoperative bacterial endophthalmitis. Animal studies had suggested that dexamethasone might decrease the concentration of vancomycin.


Prospective randomized clinical trial in a tertiary referral center.


Twenty-nine consecutive patients with suspected postoperative bacterial endophthalmitis underwent a vitreous biopsy followed by intravitreal injection of antibiotics (0.2 mg vancomycin, 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. In 18 patients, a second biopsy was taken for repeat culture and measurement of vancomycin and dexamethasone concentrations.


In 20/29 patients (69%) the first vitreous cultures were positive; the second culture was negative in all cases. Thirteen out of 29 patients received dexamethasone. Dexamethasone concentrations showed an average of 25 ng/ml 3 days after injection, with an estimated half-life of 5.5 h. Vancomycin concentrations in patients given dexamethasone tended to be higher compared with those in the placebo group (P=0.061).


Intravitreal dexamethasone does not lead to decreased vancomycin concentrations, when given simultaneously in the treatment of patients with suspected bacterial endophthalmitis.


Bacterial endophthalmitis Intravitreal dexamethasone Intravitreal vancomycin 


  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.
    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
  3. 3.
    de Gans J, van de Beek D (2002) Dexamethasone in adults with bacterial meningitis. N Engl J Med 347(20):1549–1556CrossRefPubMedGoogle Scholar
  4. 4.
    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
  5. 5.
    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
  6. 6.
    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
  7. 7.
    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
  8. 8.
    Park SS, Vallar RV, Hong CH, von Gunten S, Ruoff K, D’Amico DJ (1999) Intravitreal dexamethasone effect on intravitreal vancomycin elimination in endophthalmitis. Arch Ophthalmol 117(8):1058–1062PubMedGoogle Scholar
  9. 9.
    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
  10. 10.
    Smith MA, Sorenson JA, Smith C, Miller M, Borenstein M (1991) Effects of intravitreal dexamethasone on concentration of intravitreal vancomycin in experimental methicillin-resistant Staphylococcus epidermidis endophthalmitis. Antimicrob Agents Chemother 35(7):1298–1302PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Ivan M. Gan
    • 1
  • Luana C. Ugahary
    • 1
  • Jaap T. van Dissel
    • 2
  • Jan C. van Meurs
    • 1
  1. 1.The Rotterdam Eye HospitalRotterdamThe Netherlands
  2. 2.Department of Infectious DiseasesUniversity Leiden Medical CenterLeidenThe Netherlands

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