The Role Of Intravitreal Dexamethasone As An Adjunct In The Management Of Postoperative Bacterial Endophthalmitis Sundeep Dev, Dennis P. Han, William F. Mieler, Rafael Gonzalez-Vivas, Jose S. Pulido, Robert A. Mittra, Thomas B. Connor Jr. VitreoRetinal Surgery, PA, Minneapolis, MN, USA. Medical College of Wisconsin Eye Institute, Milwaukee, WI, USA Baylor University, Cullen Eye Institute, Houston, TX, USA 4University of Illinois Eye Institute, Chicago, IL, USA Correspondence Address: Sundeep Dev, MD, VitreoRetinal Surgery. PA, 7760 France Avenue South, Suite 310, Minneapolis, MN 55435. USA. Email: Sundeep_dev@msn.com Objective: To evaluate the effect of adjunctive intravitreal dexamethasone administration on the visual outcomes of patients suffering from post-cataract extraction or secondary intraocular lens (IOL) placement-related bacterial endophthalmitis. Methods: Consecutive records for all patients treated at the Medical College of Wisconsin from 1994-1998, with endophthalmitis after cataract surgery or secondary IOL placement with at least two months follow-up were retrospectively analyzed. Complete preoperative, intraoperative, and postoperative data was collected for each patient. Patients were stratified into two groups, one that received adjunctive dexamethasone during the initial endophthalmitis treatment, and one that did not. Patients receiving systemic corticosteroids were excluded to better isolate the effect of dexamethasone. Statistical analysis was performed to compare baseline characteristics and visual outcomes between the two groups. Logistic regression analysis was performed to identify factors associated with a difference in visual outcome attributable to dexamethasone. Results: 42 eyes of 42 patients were studied; 18 receiving dexamethasone, 24 not. Baseline characteristics were similar between the two groups. 78% of patients treated vs. 75% not treated with dexamethasone demonstrated visual improvement. Mean visual improvement was 1.02 LogMAR in those receiving dexamethasone, compared to 1.35 LogMAR in those not receiving it. A final vision of at least 20/40 was achieved in 54% vs. 56% of patients in these groups, respectively. None of these differences were significant. Regression analysis failed to identify any preoperative factors associated with a visual difference associated with dexamethasone administration. Postoperative complications and needs for additional surgery were also similar between groups. Conclusions: The simultaneous administration of intravitreal dexamethasone with intravitreal antibiotics appears to result in no demonstrable additional visual benefit over standard antibiotics alone in the treatment of postoperative endophthalmitis. INTRODUCTION Bacterial endophthalmitis is a severe and potentially visual devastating complication of intraocular surgery, penetrating ocular trauma, and systemic sepsis. The incidence of bacterial endophthalmitis after cataract surgery varies between 0.06% and 0.4%. 1-4 The Endophthalmitis Vitrectomy Study (EVS), published in 1995, confirmed that the intravitreal administration of antibiotics is the cornerstone to effective treatment of bacterial endophthalmitis occurring after cataract surgery and secondary intraocular lens placement. 5 Additionally, this study demonstrated a lack of benefit for systemic antibiotic administration, and demonstrated a benefit for pars plana vitrectomy only for patients presenting with light-perception vision. Despite current treatment recommendations, visual loss from endophthalmitis remains significant and occurs as a result of the often severe associated intraocular inflammatory response. Such inflammation is stimulated by both live and dead bacteria, as well as by toxins released by the bacteria that may potentiate visual loss in spite of antibiotic therapy. 6-9 Corticosteroids have a theoretical benefit in the management of bacterial endophthalmitis. They are known The EVRS Educational Electronic Journal, Vol 1(5), 2005 © EVRS 10