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

Session Details

Session Title: Vascular Diseases & Anterior/posterior segment surgery

Session Date/Time: Sunday 29/09/2013 | 11:00-13:00

Paper Time: 12:28

Venue: Hall 3 (Level 0)

First Author: P.Koehrer FRANCE

Co Author(s):    C. Chiquet   B. Delbosc   G. Thuret   J. Berrod     

Abstract Details

Purpose:

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

Setting:

Multicentre study involving six French University Hospitals: Besançon, Dijon, Grenoble, Nancy, Saint-Etienne, Strasbourg.

Methods:

We conducted a prospective, randomized, single-masked study including patients with acute post cataract surgery endophthalmitis. After vitreous and aqueous sampling for microbiological analysis, 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 were administered 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 as defined by the Endophthalmitis Vitrectomy Study. 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 (CI 95%: 10.29-17.97) in the group 1 and 12.52 mmHg (CI 95%: 10.49-14.55) in the group 2.

Conclusions:

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 final cohort of 100 cases.

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