Adjunctive steroid therapy versus antibiotics alone for acute endophthalmitis after intraocular procedure

Abstract

Background Endophthalmitis refers to severe infection within the eye that involves the aqueous humor or vitreous humor, or both, and threatens vision. Most cases of endophthalmitis are exogenous (i.e. due to inoculation of organisms from an outside source), and most exogenous endophthalmitis is acute and occurs after an intraocular procedure. The mainstay of treatment is emergent administration of broadspectrum intravitreous antibiotics. Due to their anti-inflammatory effects, steroids in conjunction with antibiotics have been proposed to be beneficial in endophthalmitis management. Objectives To assess the effects of antibiotics combined with steroids versus antibiotics alone for the treatment of acute endophthalmitis following intraocular surgery or intravitreous injection. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials

Adjunctive steroid therapy versus antibiotics alone for acute endophthalmitis after intraocular procedure

“…We conducted this review according to our published Cochrane protocol (Kim 2016). We included randomized controlled trials in our primary analyses.…”

Alternative Intravitreal Antibiotics

“…Corticosteroids have very short t1/2 values in the vitreous cavity. 47,96,97 In animal models of endophthalmitis, the injection of corticosteroids at the beginning of the infections along with antibiotics reduces the overall inflammatory response. Administration of this treatment in the late phases of the infection decreases vitreous flare.…”

“…96 This in turn increases their bioavailability and theoretically improves outcomes (Tables 1 and 2). 97,100 However, clinical studies results are mixed, and there is uncertainty regarding its real retinal toxicity, with some studies reporting a harmful effect in more severe cases of endophthalmitis. 47 Although the cause for the latter is not well understood.…”

“…98,101 Animal models of endophthalmitis have shown a significant decrease in the inflammatory response when combined with antibiotics without interfering with the antibiotic mechanism of action. 97 Several adverse reactions have been associated with the intravitreal use of triamcinolone, such as increased intraocular pressure, cataract formation, and sterile endophthalmitis (Table 2). 96 • Dexamethasone: Dexamethasone has a short t1/ 2 and is completely eliminated from the vitreous cavity in 3 days.…”

“…96 • Dexamethasone: Dexamethasone has a short t1/ 2 and is completely eliminated from the vitreous cavity in 3 days. 97,102 In animal models of endoph-thalmitis due to Staphylococcus aureus, the intravitreal use of dexamethasone along with antibiotics improves the inflammatory response without altering the bacteriological or clinical outcome. 102 A similar result has been observed in models of Pseudomonas and E. faecalis endophthalmitis.…”