Purpose. To report the visual acuity (VA) outcomes and culture results of delayed-onset bleb-associated endophthalmitis (BAE) with and without intravitreal dexamethasone (IVD). Methods. Retrospective nonrandomized comparative case series of BAE at Bascom Palmer Eye Institute between January 1, 1996 and December 31, 2009. Clinical data were compared using the 2-sided Student's t-test for patients who received IVD and patients who did not receive IVD. Results. 70/83 (84%) received IVD, and 13/83 (16%) did not receive IVD. Mean baseline VA was 20/90 in the IVD group and 20/70 in the group that did not receive IVD ( ). Mean presenting VA was 0.9/200 in the IVD group and 1.7/200 in the group that did not receive IVD ( ). Repeat cultures were positive in 2/70 (3%) IVD cases and 1/13 (8%) cases that did not receive IVD ( ). Mean VA at 1 month was 5/200 in the IVD group and 1.8/200 in the group that did not receive IVD, logMARΔ of 0.85 and 1.56, respectively ( ). Mean VA at 3 months was 7/200 in the IVD group and 3/200 in the group that did not receive IVD, logMARΔ of 0.74 and 1.33, respectively ( ). Conclusion. In the current study of BAE, IVD was associated with improved short-term VA outcomes without an increased rate of persistent infection. 1. Introduction Since 1974 intravitreal dexamethasone (IVD) has been used as an adjunct to intravitreal antibiotics in the management of bacterial endophthalmitis [1–3]. In 1992, Irvine et al. reported favorable outcomes in a series of Gram-negative endophthalmitis cases treated with adjunctive IVD [2]. In 2004 43% of retina specialists responded that they use IVD in the management of postcataract endophthalmitis [4]. The role of IVD in the management of bacterial endophthalmitis remains controversial due to contradictory results reported by small, comparative studies [5–8]. In delayed-onset bleb-associated endophthalmitis (BAE), the majority of reported cases, 53–82%, received adjunctive IVD [9–12]. No BAE series however has yet reported the VA outcomes of cases treated with and without IVD. Unlike postcataract endophthalmitis, BAE is commonly associated with virulent Streptococcus and Gram-negative organisms [10–13]. If IVD potentiates intraocular infection then VA outcomes may be worse in BAE cases treated with IVD. Additionally, the culture data of second biopsies in BAE cases treated with IVD may manifest a higher rate of persistent infection. The current study reports the VA outcomes and culture results of BAE cases treated with and without IVD to further clarify the role IVD plays in the management of bacterial
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