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

Emami, Sara; Kitayama, Ken; Coleman, Anne L.

doi:10.1002/14651858.cd012131.pub3

Cited by 6 publications

(7 citation statements)

References 58 publications

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“…This is important in evaluating possible benefits to be drawn from similar studies for fungal endophthalmitis and represents necessary steps to drawing conclusions and establishing the mainstays of treatment. In 2022, a review of four randomized controlled trials comparing the effectiveness of adjunctive steroids versus antibiotics alone in managing acute bacterial endophthalmitis suggested a possible improvement in visual outcomes at 3 months when using adjunctive steroids, although this result was not statistically significant [41]. Their conclusion also contained suggestions for future studies which might be applied broadly and utilized in any future studies which might investigate adjuvant steroids in fungal endophthalmitis.…”

Section: Discussionmentioning

confidence: 99%

“…Their conclusion also contained suggestions for future studies which might be applied broadly and utilized in any future studies which might investigate adjuvant steroids in fungal endophthalmitis. These suggestions included examining specific clinical settings, focusing and stratifying based on causative organism or etiology, and also including outcomes based on patient symptomology and establishing uniform outcomes that are consistent between studies short-and long-term intervals [41].…”

Section: Discussionmentioning

confidence: 99%

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The Role of Adjuvant Systemic and Intravitreal Corticosteroids in Fungal Endophthalmitis Treatment

Azhari,

Tetelbom,

Sallam

2023

JoF

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Endophthalmitis refers to inflammation involving internal ocular structures, including the anterior and posterior eye segments, associated with infectious agents, most commonly bacteria and fungi. This review focuses on endophthalmitis caused by fungi. Medical and surgical management are the two main treatment modalities for fungal endophthalmitis, with medical management utilizing systemic or intravitreal antifungals. The use of systemic or intravitreal corticosteroids as an adjuvant treatment to dampen the severity of inflammation is controversial. Based on the pathobiology of fungal endophthalmitis as well as the mechanism of action of corticosteroids, it was hypothesized that corticosteroids affected the immune response against fungal infection. In vitro studies mostly carried out during the 1980s showed that dexamethasone plays a role in the suppression of phagocytosis of yeasts and demonstrated the facilitation of yeast proliferation by dexamethasone. In vivo studies analysis was compromised entirely of retrospective studies describing steroid use in fungal endophthalmitis, with the outcomes of the patients in these studies varying greatly and often being anecdotally noted, thus difficult to discern any definitive results. Given the limited clinical data and the heterogeneity of the existing studies, additional experimentation human studies with clinical trials or observations over more extended periods analyzing the effect of systemic and intravitreal corticosteroids in fungal endophthalmitis are needed before definitive conclusions can be drawn.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Role of Adjuvant Systemic and Intravitreal Corticosteroids in Fungal Endophthalmitis Treatment

Azhari,

Tetelbom,

Sallam

2023

JoF

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“…Although the role of steroids as adjuvant therapy for AE remains controversial, our current study does not attempt to address this. [23][24][25] Finally, as the low incidence of AE after IVI therapy meant that our small sample size depended heavily on external patient referrals, this could have been a significant source of bias. It is likely that these patients were referred to our practice for advanced management because they presented with more advanced/serious disease.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Acute Endophthalmitis After Intravitreal Delivery of Vascular Endothelial Growth Factor Inhibitors Versus Steroids

Adams

Sodhi

Vagaggini

et al. 2023

Retina

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Purpose: To compare patients with acute endophthalmitis after intravitreal injection of vascular endothelial growth factor (VEGF) inhibitors vs. steroids.Methods: Retrospective single-center, nonrandomized interventional study from 2013 to 2021.Patients underwent vitreous biopsy before initiating treatment and were divided into the following cohorts: (1) anti-VEGF managed medically (T&I-anti-VEGF), (2) anti-VEGF managed by immediate pars plana vitrectomy (PPV-anti-VEGF), and (3) steroid therapy and managed medically or by pars plana vitrectomy (steroid).Results: A total of 141 patients were analyzed. The steroid cohort demonstrated significantly worse presenting (median = 2.80 logarithm of the minimum angle of resolution [logMAR]; P # 0.01) and final (median = 2.30 logMAR) best-corrected visual acuity compared with T&I-anti-VEGF (presenting: median = 2.00 logMAR; final: median = 0.40 logMAR) and pars plana vitrectomy-anti-VEGF cohorts (presenting: median = 2.30 logMAR; final: median = 0.48 logMAR). There was no significant (P = 0.33) difference in the final best-corrected visual acuity between T&I-anti-VEGF and pars plana vitrectomyanti-VEGF cohorts. There were no significant (P $ 0.63) differences among cohorts in best-corrected visual acuity before acute endophthalmitis diagnosis (T&I-anti-VEGF: median = 0.40 logMAR; pars plana vitrectomy-anti-VEGF: median = 0.40 logMAR; steroid: median = 0.44 logMAR). Microbial cultures revealed similar profiles for all cohorts.Conclusion: Acute endophthalmitis after intravitreal injection steroid therapy had worse outcomes compared with anti-VEGF therapy.

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“…A recent study in the Cochrane Library states that the currently available evidence on the effectiveness of adjunctive steroid therapy versus antibiotics alone in managing acute endophthalmitis after intraocular surgery is inadequate [ 153 ]. A combined analysis of a very limited number of studies suggests that adjunctive steroids might provide a higher chance of having a better visual outcome at three months [ 153 ]. Moreover, another study shows a higher rate of enucleation/evisceration in patients who did not receive steroid therapy [ 147 ].…”

Section: Discussionmentioning

confidence: 99%

Gram-Negative Endogenous Endophthalmitis: A Systematic Review

et al. 2022

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Background: Gram-negative bacteria are causative agents of endogenous endophthalmitis (EBE). We aim to systematically review the current literature to assess the aetiologies, risk factors, and early ocular lesions in cases of Gram-negative EBE. Methods: All peer-reviewed articles between January 2002 and August 2022 regarding Gram-negative EBE were included. We conducted a literature search on PubMed and Cochrane Controlled Trials. Results: A total of 115 studies and 591 patients were included, prevalently Asian (98; 81.7%) and male (302; 62.9%). The most common comorbidity was diabetes (231; 55%). The main aetiologies were Klebsiella pneumoniae (510; 66.1%), Pseudomonas aeruginosa (111; 14.4%), and Escherichia coli (60; 7.8%). Liver abscesses (266; 54.5%) were the predominant source of infection. The most frequent ocular lesions were vitreal opacity (134; 49.6%) and hypopyon (95; 35.2%). Ceftriaxone (76; 30.9%), fluoroquinolones (14; 14.4%), and ceftazidime (213; 78.0%) were the most widely used as systemic, topical, and intravitreal anti-Gram-negative agents, respectively. The most reported surgical approaches were vitrectomy (130; 24.1%) and evisceration/exenteration (60; 11.1%). Frequently, visual acuity at discharge was no light perception (301; 55.2%). Conclusions: Gram-negative EBEs are associated with poor outcomes. Our systematic review is mainly based on case reports and case series with significant heterogeneity. The main strength is the large sample spanning over 20 years. Our findings underscore the importance of considering ocular involvement in Gram-negative infections.

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

Abstract: Adjunctive steroid therapy versus antibiotics alone for acute endophthalmitis a er intraocular procedure (Review)

Cited by 6 publications

References 58 publications

The Role of Adjuvant Systemic and Intravitreal Corticosteroids in Fungal Endophthalmitis Treatment

The Role of Adjuvant Systemic and Intravitreal Corticosteroids in Fungal Endophthalmitis Treatment

Clinical Outcomes of Acute Endophthalmitis After Intravitreal Delivery of Vascular Endothelial Growth Factor Inhibitors Versus Steroids

Gram-Negative Endogenous Endophthalmitis: A Systematic Review

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