Abstract
BackgroundThe purpose of this study was to evaluate the role of systemic steroids in post-procedural endophthalmitis as the role of intravitreal steroids in treatment algorithms of endophthalmitis remain controversial.MethodsThis is a retrospective analysis from a single tertiary referral center of all patients older than 18 years old that developed presumed post-procedure endophthalmitis and were treated at our center from 2009 to 2018.ResultsEighty-three patients were followed after being treated for post-procedural endophthalmitis that either received systemic steroids or did not around the time of diagnosis. Almost 30 % of all patients regained a final visual acuity of 20/40 or better, while 31.2% had poor visual outcomes of count fingers or worse. Non-clearing debris was the most significant long-term complication. Visual improvement plateaued in 67.7% by 1 month after diagnosis and initial treatment in both groups. There was no difference in visual outcomes when comparing the sixteen patients that received systemic steroids and the sixty-seven that did not; however, no enucleation or evisceration was required in patients receiving systemic steroids. Five patients that did not receive systemic steroids required an enucleation or evisceration due to a blind, painful eye.ConclusionsThe use of systemic steroids does not seem to worsen long-term outcomes of endophthalmitis compared to those patients that did not receive them and they may prove beneficial in the most severe cases by reducing the risk of losing the globe altogether.
Highlights
The purpose of this study was to evaluate the role of systemic steroids in post-procedural endophthalmitis as the role of intravitreal steroids in treatment algorithms of endophthalmitis remain controversial
Given the significant ocular morbidity associated with intraocular infections, and despite the introduction of systemic antibiotics with better ocular penetrance (i.e.fluoroquinolones), and the use of smaller vitrectomy port sizes, the Endophthalmitis Vitrectomy Study (EVS) published in 1995 remains the foundation of current treatment algorithms [4]
Eighty-three patients who developed and were treated for endophthalmitis following an intraocular procedure were identified by retrospective chart review from 2009 to 2018 at the John A
Summary
The purpose of this study was to evaluate the role of systemic steroids in post-procedural endophthalmitis as the role of intravitreal steroids in treatment algorithms of endophthalmitis remain controversial. Approximately 40% of endophthalmitis cases associated with cataract surgery and greater than 90% of those associated with trabeculectomy surgeries will develop visual acuities worse than 20/200. These post-operative infections result in an estimated 83% rise in overall medical costs alone [1,2,3]. Conrady et al BMC Ophthalmology (2020) 20:181 inflammation, and indolent courses, there is no consensus as to the management of post-procedure endophthalmitis [5] This has become increasingly apparent with the advent and expansion of intravitreal injections for multiple chorioretinal diseases since the EVS was conducted [5, 6]. Recent attention has been directed towards prevention strategies and early detection of post-operative endophthalmitis rather than management to improve long-term outcomes once an infection has manifested [5, 10]
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