Corticosteroid Therapy May Improve Visual Outcomes in Endophthalmitis

In patients presenting with endophthalmitis, oral steroids can increase the possibility that they will gain 3 lines of vision or more at 6 months, according to a study published in Ophthalmology Retina.

Researchers conducted the retrospective nonrandomized chart review at Duke Eye Center between January 1, 2009, and January 1, 2018. They evaluated 133 eyes of 130 patients with endophthalmitis to determine practice patterns and visual outcomes of those who received systemic corticosteroid therapy. Patients had at least 6 months follow-up at the time of their endophthalmitis diagnosis.

The researchers assessed clinical presentation, management decisions, and outcomes. Each patient had their visual acuities measured when endophthalmitis presented, and 6 months after. A total of 33 eyes (25%) treated with oral steroids received further analysis.

They found that culture-positive endophthalmitis (odds ratio [OR] 2.7; 95% confidence interval [CI], 1.2e6.2), hypotony (OR, 4.2; 95%CI, 1.3e13.6), conjunctival hyperemia (OR, 2.6; 95% CI, 1.02e6.5), and anterior chamber fibrin on examination (OR, 2.7; 95% CI, 1.1e6.3) were associated with oral steroid use. Endogenous endophthalmitis cases were less likely to receive oral steroids (OR, 0.2; 95% CI, 0.05e0.92).

Patients who received oral steroids were more likely to experience visual acuity improvement of 3 lines or more following endophthalmitis (OR, 2.8; 95% CI, 1.1e6.7) than those who did not, the report shows. In addition, they showed “greater improvement from presentation to month 6” (e1.102 logMAR] vs e0.655 logMAR; P 1⁄4 0.024).

“This study adds important information that will guide our management decisions until a randomized controlled clinical trial determining whether systemic corticosteroid therapy has an independent influence on visual outcomes is conducted,” according to investigators.

The study’s limitations include its variety of endophthalmitis causes, which could limit its “ability to infer the impact of systemic corticosteroids for certain groups,” and its retrospective design, which excludes potential cofounders that could have impacted outcomes, such as if topical eye drops administered to some patients might have changed visual acuity.

“We also had a limited number of eyes that received intravitreal steroids; therefore, we are unable to determine whether intravitreal steroids alone would have led to similar outcomes as patients treated with oral steroids. Because of the scope of our study, we were not able to fully assess the systemic complications arising from steroid therapy, nor were we able to assess all patient comorbidities that might have influenced the decision to administer or defer oral steroids,” the report says.

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Robbins CB, Ma J, Feng HL, Fekrat S. Clinical decision making and visual outcomes in endophthalmitis treated with systemic corticosteroids. Ophthalmol Retina. 2020;4(11):1103-1108. doi: 10.1016/j.oret.2020.04.026