‘Shoot first, ask questions later’

Benefits of intravitreal injections in suspected endophthalmitis

Dermot McGrath

Posted: Friday, September 6, 2019

Jan Van Meurs

The benefits of early intervention using intravitreal antibiotics in cases of suspected bacterial endophthalmitis after cataract surgery were highlighted by Prof Jan van Meurs at a packed session on endophthalmitis/uveitis at the 19th EURETINA Congress.

“The evidence suggests that we really need to act quickly as soon as the patient presents with suspected endophthalmitis. It is a case of ‘shoot first and ask questions later’ as the evidence shows there is a good outcome for most patients even with antibiotic injections only,” he said.

Prof van Meurs, Rotterdam Eye Hospital, the Netherlands, added that intravitreal dexamethasone, either with or without preservatives, should no longer be used.

“Our group recently showed that dexamethasone as an adjuvant to intravitreal antibiotics does not improve visual acuity in patients treated for suspected bacterial endophthalmitis after cataract surgery,” he said.

Prof van Meurs’ double-blind, prospective, multi-centre, randomised, placebo-controlled trial included 167 patients over a 10-year period, 81 of whom were treated with dexamethasone and 86 with placebo.

The final best-corrected visual acuity (BCVA) did not differ between the dexamethasone and the placebo group, nor did the number of patients with final vision of no light perception.

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