Intraocular dexamethasone produces a harmful effect on treatment of experimental Staphylococcus aureus endophthalmitis

T. A. Meredith, H. E. Aguilar, C. Drews, A. Sawant, S. Gardner, L. A. Wilson, H. E. Grossniklaus, R. K. Forster, R. M. Burde, E. Raab

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43 Scopus citations

Abstract

Background: We created a standardized model of severe Staphylococcus aureus endophthalmitis in the aphakie rabbit eye to test various treatment strategies involving corticosteroid administration in addition to vitrectomy and antibiotic treatment. Materials and Methods: In 71 aphakie New Zealand albino rabbit eyes, experimental endophthalmitis was created by injecting 105 colony-forming units of Staphylococcal aureus. The animals were divided into 5 groups. One control group was followed up without treatment, while 4 groups were treated with vitrectomy and intraocular cefazolin injection. Two groups were also treated with intramuscular methylprednisolone, 1 group beginning on the day of surgery and 1 group beginning on the following day. In the final group, dexamethasone, 400 μg, was injected into the vitreous cavity at the close of surgery. Culture results were compared on the first 2 days after surgery. Inflammatory scores, including development of total corneal opacity, were assessed over a 21-day follow-up period, and histopathologic grading was carried out at the conclusion of the clinical observations. Results: Simultaneous administration of systemic corticosteroids beginning on the day of vitrectomy decreased inflammatory scores 1 week after institution of therapy but did not affect final scores. Delay on initiation of intramuscular corticosteroid until the first postoperative day negated the positive effects. Administration of intraocular corticosteroids was associated with an increase in inflammatory scores throughout the period of observation, an increase in percentage of eyes that developed opaque corneas, an increase in choroidal inflammation graded moderate severe, and an increase in retinal necrosis compared with vitrectomy and cefazolin injection alone. Conclusions: This data suggest caution in the use of intraocular corticosteroids in treatment of severe endophthalmitis.

Original languageEnglish (US)
Pages (from-to)241-257
Number of pages17
JournalTransactions of the American Ophthalmological Society
Volume94
StatePublished - Dec 16 1996

ASJC Scopus subject areas

  • Ophthalmology

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    Meredith, T. A., Aguilar, H. E., Drews, C., Sawant, A., Gardner, S., Wilson, L. A., Grossniklaus, H. E., Forster, R. K., Burde, R. M., & Raab, E. (1996). Intraocular dexamethasone produces a harmful effect on treatment of experimental Staphylococcus aureus endophthalmitis. Transactions of the American Ophthalmological Society, 94, 241-257.