The effect of a preoperative subconjuntival injection of dexamethasone on
blood-retinal barrier breakdown following scleral buckling retinal detachment
surgery: a prospective randomized placebo-controlled double blind clinical trial.
Author(s): Bali E, Feron EJ, Peperkamp E, Veckeneer M, Mulder PG, van Meurs JC.
Affiliation(s): The Rotterdam Eye Hospital, Rotterdam, The Netherlands.
Publication date & source: 2010, Graefes Arch Clin Exp Ophthalmol. , 248(7):957-62
BACKGROUND: Blood-retinal barrier breakdown secondary to retinal detachment and
retinal detachment repair is a factor in the pathogenesis of proliferative
vitreoretinopathy (PVR). We wished to investigate whether an estimated 700 to
1000 ng/ml subretinal dexamethasone concentration at the time of surgery would
decrease the blood-retinal barrier breakdown postoperatively.
METHODS: Prospective, placebo-controlled, double blind clinical trial. In 34
patients with rhegmatogenous retinal detachment scheduled for conventional
scleral buckling retinal detachment surgery, a subconjunctival injection of 0.5
ml dexamethasone diphosphate (10 mg) or 0.5 ml placebo was given 5-6 hours before
surgery. Differences in laser flare photometry (KOWA) measurements taken 1, 3 and
6 weeks after randomisation between dexamethasone and placebo were analysed using
mixed model ANOVA, while correcting for the preoperative flare measurement.
RESULTS: Six patients did not complete the study, one because of recurrent
detachment within 1 week, and five because they missed their postoperative laser
flare visits. The use of dexamethasone resulted in a statistically significant
decrease in laser flare measurements at the 1-week postoperative visit.
CONCLUSION: The use of a preoperative subconjunctival injection of dexamethasone
decreased 1-week postoperative blood-retina barrier breakdown in patients
undergoing conventional scleral buckling retinal detachment surgery. This steroid
priming could be useful as a part of a peri-operative regime that would aim at
decreasing the incidence of PVR.
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