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A prospective multicentre randomized placebo-controlled superiority trial in patients with suspected bacterial endophthalmitis after cataract surgery on the adjuvant use of intravitreal dexamethasone to intravitreal antibiotics.
Manning, Sonia; Ugahary, Luana C; Lindstedt, Eric W; Wubbels, René J; van Dissel, Jaap T; Jansen, Jan T G; Gan, Ivan; van Goor, Arnoud T; Bennebroek, Carlien A; van der Werf, Dymph J; Ossewaarde-van Norel, Annette; Mayland Nielsen, Chris C; Tilanus, Mauk; van den Biesen, Pieter R; Schellekens, Peter A; La Heij, Ellen; Faridpooya, Koorosh; van Overdam, Koen; Veckeneer, Marc; van Meurs, Jan C.
Afiliação
  • Manning S; The Rotterdam Eye Hospital, Rotterdam, the Netherlands.
  • Ugahary LC; The Rotterdam Eye Hospital, Rotterdam, the Netherlands.
  • Lindstedt EW; The Rotterdam Eye Hospital, Rotterdam, the Netherlands.
  • Wubbels RJ; Rotterdam Ophthalmic Institute, Rotterdam, the Netherlands.
  • van Dissel JT; Leiden University Medical Centre, Leiden, the Netherlands.
  • Jansen JTG; The Rotterdam Eye Hospital, Rotterdam, the Netherlands.
  • Gan I; The Rotterdam Eye Hospital, Rotterdam, the Netherlands.
  • van Goor AT; The Rotterdam Eye Hospital, Rotterdam, the Netherlands.
  • Bennebroek CA; University Medical Center Utrecht, Utrecht, the Netherlands.
  • van der Werf DJ; University Medical Center Utrecht, Utrecht, the Netherlands.
  • Ossewaarde-van Norel A; University Medical Center Utrecht, Utrecht, the Netherlands.
  • Mayland Nielsen CC; Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
  • Tilanus M; Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
  • van den Biesen PR; University Medical Center Utrecht, Utrecht, the Netherlands.
  • Schellekens PA; University Medical Center Utrecht, Utrecht, the Netherlands.
  • La Heij E; University Medical Center Utrecht, Utrecht, the Netherlands.
  • Faridpooya K; The Rotterdam Eye Hospital, Rotterdam, the Netherlands.
  • van Overdam K; The Rotterdam Eye Hospital, Rotterdam, the Netherlands.
  • Veckeneer M; The Rotterdam Eye Hospital, Rotterdam, the Netherlands.
  • van Meurs JC; The Rotterdam Eye Hospital, Rotterdam, the Netherlands.
Acta Ophthalmol ; 96(4): 348-355, 2018 Jun.
Article em En | MEDLINE | ID: mdl-29214740
PURPOSE: We aimed to determine whether intravitreal dexamethasone as an adjuvant to intravitreal antibiotics is beneficial in the treatment of suspected bacterial endophthalmitis after cataract surgery. METHODS: Randomized, placebo-controlled superiority trial in three tertiary referral centres in the Netherlands. Patients with suspected bacterial endophthalmitis within 6 weeks after cataract surgery were eligible. A diagnostic vitreous biopsy was taken for culture, and patients received intravitreal injections of 400 µg dexamethasone (without preservatives) or placebo, in addition to 0.2 mg vancomycin and 0.05 mg gentamicin. The vancomycin and dexamethasone or placebo injections were repeated once at day 3 or 4. Primary outcome measure was best-corrected visual acuity (BCVA) at 1 year. RESULTS: Between 1 November 2004 and 1 March 2014 (excluding two interruptions totalling 20 months), 324 eligible patients presented. A total of 167 patients (81 dexamethasone, 86 placebo) were available for the intention-to-treat analysis. Biopsies of 114 patients (68%) were culture-positive. Final BCVA did not differ between the dexamethasone and the placebo group (logMAR 0.31 ± 0.58 versus 0.27 ± 0.50; p = 0.90), nor did the number of patients with final vision of no light perception (LP, 7 versus 13). Pain, corneal oedema, the absence of a red fundus reflex on presentation, LP on presentation and culture of virulent pathogens from biopsy were statistically significantly associated with an unfavourable visual outcome. CONCLUSION: Intravitreal dexamethasone without preservatives as an adjuvant to intravitreal antibiotics does not improve visual acuity (VA) in patients treated for suspected bacterial endophthalmitis after cataract surgery.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecção da Ferida Cirúrgica / Dexametasona / Gentamicinas / Vancomicina / Extração de Catarata / Infecções Oculares Bacterianas / Endoftalmite Tipo de estudo: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male Idioma: En Revista: Acta Ophthalmol Assunto da revista: OFTALMOLOGIA Ano de publicação: 2018 Tipo de documento: Article País de afiliação: Holanda País de publicação: Reino Unido

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecção da Ferida Cirúrgica / Dexametasona / Gentamicinas / Vancomicina / Extração de Catarata / Infecções Oculares Bacterianas / Endoftalmite Tipo de estudo: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male Idioma: En Revista: Acta Ophthalmol Assunto da revista: OFTALMOLOGIA Ano de publicação: 2018 Tipo de documento: Article País de afiliação: Holanda País de publicação: Reino Unido