Visual outcomes following the use of intravitreal steroids in the treatment of postoperative endophthalmitis

Shah, Gaurav K.; Stein, Joshua D.; Sharma, Sanjay; Sivalingam, Arunan; Benson, William E.; Regillo, Carl D.; Brown, Gary C.; Tasman, William

doi:10.1016/s0161-6420(99)00139-6

Cited by 136 publications

(71 citation statements)

References 12 publications

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“…The use of steroids in the treatment of endophthalmitis has been controversial and there remains no clear evidence of their benefit for this disease. Experimental models and clinical studies have reported that concomitant administration of dexamethasone with antibiotics were detrimental , beneficial (Gan, et al, 2005;Liu, et al, 2000;Smith, et al, 1997;Yildirim, et al, 2002) or had no effect Ermis, et al, 2005;Pollack, et al, 2004;Shah, et al, 2000). Despite the controversy, dexamethasone is frequently used as an adjunct to antibiotics for the treatment of endophthalmitis.…”

Section: Therapeutic Challengesmentioning

confidence: 99%

Bacterial endophthalmitis: Therapeutic challenges and host–pathogen interactions

Callegan

Gilmore

Gregory

et al. 2007

Progress in Retinal and Eye Research

148

153

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Endophthalmitis is an infection of the posterior segment of the eye that frequently results in loss of vision. This devastating result occurs despite prompt and often aggressive therapeutic and surgical intervention. Over the past decade, research has centered on determining the bacterial and host factors involved in this potentially blinding disease. The initial focus on the bacterial factors responsible for intraocular virulence has recently expanded into analysis the inflammatory response to infection, including the molecular and cellular interactions between the pathogen and host. This review discusses the epidemiology and therapeutic challenges posed by endophthalmitis, as well as recent findings from the analysis of interactions between the host and pathogen. Based on these findings, a model for the pathogenesis of endophthalmitis is presented. A more comprehensive understanding of the molecular and cellular interactions taking place between pathogen and host during endophthalmitis will expose possible therapeutic targets designed to arrest the infection and prevent vision loss.

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Section: Therapeutic Challengesmentioning

confidence: 99%

Bacterial endophthalmitis: Therapeutic challenges and host–pathogen interactions

Callegan

Gilmore

Gregory

et al. 2007

Progress in Retinal and Eye Research

148

153

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“…21 In a recent trial, patients who received intravitreal steroid for the treatment of postoperative endophthalmitis had a significantly reduced likelihood of obtaining a three-line improvement in visual acuity. 22 This was a retrospective, nonrandomized, comparative trial, and was criticized for bias towards selection of patients with more severe intraocular inflammation receiving intravitreal steroid. 23 The use of intravitreal steroid in the treatment of endophthalmitis requires evaluation by a randomized, controlled study.…”

Section: Managementmentioning

confidence: 99%

Surveillance of endophthalmitis following cataract surgery in the UK

Kamalarajah

Silvestri

Sharma

et al. 2004

Eye

100

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Aims To estimate the incidence of acuteonset presumed infectious endophthalmitis (PIE) following cataract surgery in the UK and provide epidemiological data on the presentation, management, microbiology, and outcome of cases of endophthalmitis. Methods Cases were identified prospectively by active surveillance through the British Ophthalmological Surveillance Unit reporting card system, for the 12-month period October 1999 to September 2000 inclusive. Questionnaire data were obtained from ophthalmologists throughout the UK at baseline and 6 months after diagnosis. Under-reporting was estimated by independently contacting units with infection databases. Results Data were available on 213 patients at baseline and 201 patients at follow-up. The minimum estimated incidence of PIE was 0.086 per 100 cataract extractions and the corrected incidence was 0.14 per 100 cataract extractions. For the management of PIE, 96% of patients received intravitreal, 30% subconjunctival, 65% oral, and 17% intravenous antibiotics. In all, 17% of patients received intravitreal steroid. From the intraocular samples taken for microbiological analysis, 56% were culture positive. At followup, 48% of patients achieved visual acuity of 6/ 12 or better and 66% achieved better than 6/60. 13% of patients were unable to perceive light or had evisceration of the globe. Conclusions The incidence of PIE after cataract surgery in the UK is comparable to that of other studies. Approximately 50% of patients achieved a visual acuity close to the driving standard.

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“…Die unmittelbare intravitreale Instillation von Dexamethason (0,4 mg/0,1 ml) wird in der Literatur kontrovers diskutiert [14,15]. Im Rahmen der EVS wurden keine intravitrealen Steroide appliziert, eine lokale und systemische Steroidtherapie (beispielsweise Prednisolon 100 mg/d oral) wird üblicherweise verabreicht.…”

Section: Steroideunclassified

Prophylaxe und Therapie der akuten postoperativen Endophthalmitis nach Kataraktoperation – state of the art

Egger

2016

Spektrum Augenheilkd.

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ZusammenfassungHintergrund Die Inzidenz der akuten postoperativen Endophthalmitis konnte durch verbesserte Operationstechniken und perioperative Regime in den letzten Jahrzehnten deutlich reduziert werden, dennoch stellt die Erkrankung nach wie vor eine das Sehvermögen massiv bedrohende postoperative Komplikation dar. Die derzeit -Evidenz basiert -optimalen perioperativen und therapeutischen Regime werden erläutert. Resultate Die Inzidenz der akuten postoperativen Endophthalmitis kann nach sorgfältiger präoperativer Antisepsis (Polyvidon-Jod 5 % in den Bindehautsack) und der unmittelbar am Ende der OP erfolgenden Instillation von 0,1 ml Curocef (1 mg/0,1 ml) in die Vorderkammer des Auge hochsignifikant reduziert werden. Bei Auftreten einer akuten postoperativen Endophthalmitis ist die rasche intravitreale Antibiotika Instillation von entscheidender Bedeutung. Die Therapie der Wahl besteht in der intravitrealen Applikation von Vancomycin (1 mg/0,1 ml) und Ceftazidim (2 mg/0,1 ml). Prophylaxis and therapy of acute postoperative endophthalmitis after cataract extraction -state of the art SummaryBackground Cataract extraction is one of the most frequently performed surgical procedures in medicine. Incidence could be lowered over the last decades due to advances in operation techniques and perioperative regimes. However, acute postoperative endophthalmitis still remains a vision threatening disease. The up to now best -evidence based -perioperative regime to prevent the disease and recommended therapy will be discussed. Results The incidence of acute postoperative endophthalmitis can be significantly decreased by the instillation of 0.1 ml cefuroxime (1 mg/0.1 ml) into the anterior chamber at the end of the cataract operation. Acute postoperative endophthalmitis should be treated immediately by performing an intravitreal injection of vancomycin (1 mg/0.1 ml) as well as ceftazidime (2 mg/0.1 ml) and -if possible -vitrectomy. Conclusions An efficient perioperative regimen offers the possibility to decrease the incidence of acute postoperative endophthalmitis significantly. If necessary, treatment should be initiated immediately, so an improvement of visual acuity can be accomplished in many cases.

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Visual outcomes following the use of intravitreal steroids in the treatment of postoperative endophthalmitis

Cited by 136 publications

References 12 publications

Bacterial endophthalmitis: Therapeutic challenges and host–pathogen interactions

Bacterial endophthalmitis: Therapeutic challenges and host–pathogen interactions

Surveillance of endophthalmitis following cataract surgery in the UK

Prophylaxe und Therapie der akuten postoperativen Endophthalmitis nach Kataraktoperation – state of the art

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