Intravitreal dexamethasone in the management of acute endophthalmitis: A comparative retrospective study

Purpose: To compare the clinical outcome of eyes with acute bacterial endophthalmitis treated with intravitreal injection of antibiotics with or without intravitreal dexamethasone. Methods: This was a retrospective chart review of 63 eyes diagnosed with acute bacterial endophthalmitis and treated with vitreous tap and intravitreal injection of antibiotics, 19 eyes (30.2%) with and 44 eyes (69.8%) without concurrent intravitreal dexamethasone. Results: Visual acuity had significantly improved by 1 week and was maintained long-term (p<0.001). There were no differences in visual outcome or rates of ocular complications between the groups. None of the eyes treated with dexamethasone required repeated intravitreal antibiotic injection while 6 (13.6 %) of the other eyes required repeated intravitreal antibiotic injection (p = 0.09). A subset analysis of 21 eyes that presented with light perception/no light perception vision where vitrectomy was not possible demonstrated that intravitreal antibiotic injection improved vision and achieved similar visual gain as in eyes that presented with hand motion vision or better, with no higher complication rates. Conclusions: No adverse effect of intravitreal dexamethasone in the acute management of infectious endophthalmitis was noted. A trend toward less need for repeat intravitreal antibiotic therapy was noted in eyes with acute bacterial endophthalmitis treated with concurrent intravitreal dexamethasone at presentation.