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Mid-term safety and effectiveness of intravitreal dexamethasone implant to treat persistent cystoid macular edema in vitrectomized eyes for bacterial endophthalmitis

  • Medical Ophthalmology
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Abstract

Purpose

To evaluate the mid-term safety and effectiveness of intravitreal dexamethasone implant (DEX-i) for treating unresponsive to medical therapy cystoid macular edema (CME) in vitrectomized eyes for endophthalmitis.

Methods

Retrospective and interventional case series study conducted on vitrectomized eyes for endophthalmitis that developed a CME that did not adequately respond to medical therapy, who underwent 0.7-mg DEX-i. Main outcome measures were changes in central retinal thickness (CRT) and best corrected visual acuity (BCVA).

Results

Eleven eyes were included in the study. Microbiological findings of vitreous biopsies were 7 (63.6%) staphylococcus epidermidis; 3 (27.3%) Pseudomonas aeruginosa; and 1 (9.1%) Propionibacterium acnes. Median (interquartile range, IqR) duration of CME was 4.0 (3.0–4.0) months. Median (IqR) time between vitrectomy and DEX-i was 9.0 (9.0–11.0) months. Median CRT was significantly decreased from 548.0 (412.8–572.5) µm at baseline to 308.0 (281.3–365.5) µm at month 6 (p = 0.0009, Friedman test). Median BCVA significantly improved from 38.0 (30.5–44.8) letters at baseline to 50.0 (46.8–53.0) letters at month 6 (p < 0.0001, Friedman), with 9 (81.8%) eyes gaining ≥ 10 letters. Elevation of intraocular pressure was observed in one (9.1%) eye, which was successfully controlled with medical therapy. No recurrence of endophthalmitis or other complications was observed. Eight (72.7%) eyes required an additional DEX-i, while 3 (27.3%) were successfully controlled with only one DEX-i. CME recurrence occurred in 5 (62.5%) Gram-positive and 3 (100.0%) Gram-negative bacteria (p = 0.2357).

Conclusion

In vitrectomized eyes for endophthalmitis affected by CME unresponsive to medical therapy, DEX-i had an acceptable safety profile and achieved favorable outcomes. The possibility of suppressing mechanisms for infection control should be taken into account, although correct management of endophthalmitis and long time without reactivation before DEX-i reduce the risk.

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Acknowledgements

Writing and editorial assistance was provided to the authors by Antonio Martinez (MD) of Ciencia y Deporte ltd.

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Authors and Affiliations

  1. Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy

    Giancarlo Sborgia, Valentina Pastore, Rosa Anna Favale, Alessandra Sborgia, Gianluigi Giuliani, Maria Oliva Grassi, Francesco Boscia & Giovanni Alessio

  2. Eye Clinic, Hospital “SS Annunziata”, ASL Taranto, Via F. Bruno, 1, 74010, Taranto, Italy

    Alfredo Niro & Samuele Gigliola

  3. Ophthalmology, University Campus Bio Medico of Rome, 00128, Rome, Italy

    Marco Coassin

  4. Ophthalmology Unit, Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133, Rome, Italy

    Francesco Aiello

  5. Department of Ophthalmology, Policlinico Riuniti Di Foggia, University of Foggia, 71122, Foggia, Italy

    Cristiana Iaculli

  6. Department of Surgical Sciences, University of Torino, 10126, Turin, Italy

    Michele Reibaldi

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  1. Giancarlo Sborgia
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  2. Alfredo Niro
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Correspondence to Alfredo Niro.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board as well as the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Institutional Review Board (Eye Clinic of University of Bari, Bari, Italy) approved the study. Informed consent was obtained from all individual participants included in the study.

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Sborgia, G., Niro, A., Pastore, V. et al. Mid-term safety and effectiveness of intravitreal dexamethasone implant to treat persistent cystoid macular edema in vitrectomized eyes for bacterial endophthalmitis. Graefes Arch Clin Exp Ophthalmol 260, 2703–2710 (2022). https://doi.org/10.1007/s00417-022-05615-8

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