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Endophthalmitis symposium at EURETINA

Leigh Spielberg

Posted: Thursday, September 20, 2018

Endophthalmitis continues to lurk in the back of every ophthalmologist’s mind as the most dreaded of all postoperative and post-injection complications. This was evident in the large turnout for the EURETINA Symposium, “Controversies in the Management of Endophthalmitis,” held yesterday morning at the 18th EURETINA Congress.

Hosted by the FRIENDS (French Institutional Endophthalmitis Study) Group, the symposium approached several of the most difficult topics in the current management of endophthalmitis: What is the best timing for injection of antibiotics? (As early as possible.) Should adjunctive intravitreal corticosteroids be used? (No.) Is vitrectomy beneficial? (Yes, in selected cases). What about endoscopic assistance during vitrectomy? (Can be very helpful.)

Prof Jan van Meurs, Rotterdam Eye Hospital, The Netherlands, presented the results of his group’s recently published study on the potential benefit of intravitreal dexamethasone injection in addition to intravitreal antibiotics.

As Prof Catherine Creuzot-Garcher, University Hospital of Dijon, France, pointed out later in the symposium, there are several rationales for steroid use: limitation of leucocyte recruitment, stabilisation of the blood-retinal barrier, modification of the expression of inflammatory cytokines and stimulation of production of cytoprotectants.

However, these theoretical benefits were not borne out in Prof van Meurs’ clinical trial. “Our study reported good final outcomes for most patients who received only early intravitreal injections with antibiotics, and there was no added benefit by adding intravitreal dexamethasone,” he said, commenting on his group’s double-blind, prospective, multicentre, randomised, placebo-controlled trial that included 167 patients.

Prof van Meurs stressed that the most important factor in achieving good outcomes was earlier treatment.