Visual outcome after intravitreal steroid use for postoperative endophthalmitis

Abstract

In the recent article, “Visual Outcomes after the Use of Intravitreal Steroids in the Treatment of Postoperative Endophthalmitis,” Shah et al1Shah G.K. Stein J.D. Sharma S. et al.Visual outcomes after the use of intravitreal steroids in the treatment of postoperative endophthalmitis.Ophthalmology. 2000; 107: 486-489Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar stated that patients who receive intravitreal steroids have a reduced likelihood of significant visual improvement. I believe this conclusion is not warranted based on their data because of a significant potential bias in patient selection.A significantly higher percentage of patients with good visual acuity (better than 5/200) at presentation did not receive intravitreal steroids as a part of their treatment (Table 2 of the article). As such, it seems likely that patients who had milder forms of endophthalmitis were not treated with steroids, whereas the patients with more severe forms of endophthalmitis tended to be in the steroid treatment group more frequently. The authors stated that on their service, some physicians use steroids in some cases and not in others. This information suggests that these physicians use steroids more frequently in patients with more severe intraocular inflammation and in fact, this selection creates a bias toward poor visual outcomes.As such, no conclusion can be drawn from this study regarding efficacy of intravitreal steroids in the treatment of postoperative endophthalmitis. Additional studies that are randomized and prospective are required to answer this issue conclusively. In the recent article, “Visual Outcomes after the Use of Intravitreal Steroids in the Treatment of Postoperative Endophthalmitis,” Shah et al1Shah G.K. Stein J.D. Sharma S. et al.Visual outcomes after the use of intravitreal steroids in the treatment of postoperative endophthalmitis.Ophthalmology. 2000; 107: 486-489Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar stated that patients who receive intravitreal steroids have a reduced likelihood of significant visual improvement. I believe this conclusion is not warranted based on their data because of a significant potential bias in patient selection. A significantly higher percentage of patients with good visual acuity (better than 5/200) at presentation did not receive intravitreal steroids as a part of their treatment (Table 2 of the article). As such, it seems likely that patients who had milder forms of endophthalmitis were not treated with steroids, whereas the patients with more severe forms of endophthalmitis tended to be in the steroid treatment group more frequently. The authors stated that on their service, some physicians use steroids in some cases and not in others. This information suggests that these physicians use steroids more frequently in patients with more severe intraocular inflammation and in fact, this selection creates a bias toward poor visual outcomes. As such, no conclusion can be drawn from this study regarding efficacy of intravitreal steroids in the treatment of postoperative endophthalmitis. Additional studies that are randomized and prospective are required to answer this issue conclusively. Author’s replyOphthalmologyVol. 108Issue 2Preview Full-Text PDF