Eyeworld

EW CATARACT 44 September 2011 by Matt Young EyeWorld Contributing Editor When post-cataract endophthalmitis arises, some surgeons reach for steroids Patients treated with steroids and antibiotics improved by more Snellen lines O bviously when infectious endophthalmitis arises, surgeons reach for potent antibiotic treatment, but few treat the inflamma- tory component of the disease. "Endophthalmitis is defined as inflammation of the contents or cavity of the eye and usually repre- sents an infection of the vitreous," according to Eric Albrecht, M.D., Department of Ophthalmology, Uni- versity of Cape Town, South Africa. The inflammatory side of en- dophthalmitis may be considerable, but only 17% of all post-cataract en- dophthalmitis patients in the United Kingdom received intravitreal steroids as part of their treatment, Dr. Albrecht noted in a report pub- lished online in February in Ophthal- mology. That's understandable consider- ing the lack of clear guidelines in treating the inflammatory aspect of endophthalmitis, Dr. Albrecht re- ported. However, Dr. Albrecht's re- search—along with at least one previous report—suggests there is merit to using steroids in the treat- ment of endophthalmitis. By far, this is inconclusive data. Small sam- ple pools and other research that came to opposite conclusions mean the debate should continue on the steroids-for-endophthalmitis issue. Endophthalmitis patients de- serve the best treatment for this often blinding condition. If steroids help—and that's still a big if—then perhaps they should be used more frequently for these patients. Steroids for endophthalmitis? Dr. Albrecht's research was based on 62 patients who had presumed bac- terial endophthalmitis, 30 of whom received intravitreal dexamethasone as part of their treatment. The other 32 received an intravitreal placebo. All patients received intravitreal an- tibiotics. Major subgroups included post- cataract surgery endophthalmitis (32 patients, of whom 17 received the steroid), bleb-related endophthalmi- tis (13 patients, of whom nine re- ceived the steroid), endogenous endophthalmitis (three patients, of whom one received the steroid), and endophthalmitis following pars plana vitrectomy (six patients, of whom four received the steroid). The study looked at Snellen vi- sual acuity at baseline and at 3 months to determine the outcome of treatment. Mean improvement for the steroid group was 2.76 lines (range –3-9) compared to only 1.79 lines (range –3-9) in the placebo group. This difference could not be deter- mined to be statistically significant. Two views of post-op endophthalmitis Source: Nick Mamalis, M.D. Cornea Society/EBAA Fall Educational Conference Friday, October 21 8:30 a.m.–4:30 p.m. Rosen Centre Hotel Orlando, Fl. Register at www.restoresight.org Meeting support provided by

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